Individual
DR. JORDAN KING ALEXIS HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
612 BRIGHTON AVE, PORTLAND, ME 04102-2359
(207) 772-4359
Mailing address
612 BRIGHTON AVE, PORTLAND, ME 04102-2359
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN4543
ME
Other
Enumeration date
06/21/2017
Last updated
03/17/2018
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