Individual
KEITH HICKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3705 EMERSON AVE, PARKERSBURG, WV 26104-1118
(304) 485-7717
Mailing address
474 VALLEY MANOR LN, WILLIAMSTOWN, WV 26187-8249
(304) 224-4301
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4477
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2019
Last updated
08/15/2023
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