Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 8578 | NC |
NPI | 1114187812 |
---|---|
Provider Name | Dr. Travis Martin Hicks |
First Address | Gastonia, NC 28052-6430 |
Second Address | Gastonia, NC 28052-6430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 14/01/2014 |