Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 05880 | MD |
Y | 1223D0001X | Dental Public Health | 05880 | MD |
NPI | 1093971780 |
---|---|
Provider Name | Dr. Rudolph Hickman |
First Address | Owings Mills, MD 21117-3709 |
Second Address | Owings Mills, MD 21117-3709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2008 |
Last Update Date | 01/08/2008 |