Individual
THOMAS RANDAL HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
13305 NW CORNELL RD STE A, PORTLAND, OR 97229-5987
(503) 644-5433
(503) 644-5436
Mailing address
13305 NW CORNELL RD STE A, PORTLAND, OR 97229-5987
(503) 644-5433
(503) 644-5436
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7362
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922168335
—
OR
Enumeration date
12/08/2006
Last updated
02/04/2023
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