Active NPI
Cecilia Jo Hickam, RDH-EA, OMT
- Dental Hygienist
- Eagle, ID
National Provider Identifier
1376940668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- DH-0356-EA
- Practice address
- 1121 E. State Street
Suite - 102-D
Eagle, ID 83616 - Phone
- (208) 584-9060
- NPI assigned
- Dec 2, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | DH-0356-EA | ID | Primary |
Addresses
Primary practice location
1121 E. State Street
Suite - 102-D
Eagle, ID 83616
Mailing address
1121 E. State Street
Suite 102-D
Eagle, ID 83616
Phone (208) 584-9060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DH-0356-EA | ID | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1417478400000",
"number": "1376940668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1121 E. STATE STREET",
"address_2": "SUITE 102-D",
"city": "EAGLE",
"state": "ID",
"postal_code": "83616",
"telephone_number": "208-584-9060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1121 E. STATE STREET",
"address_2": "SUITE - 102-D",
"city": "EAGLE",
"state": "ID",
"postal_code": "83616",
"telephone_number": "208-584-9060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKAM",
"first_name": "CECILIA",
"middle_name": "JO",
"name_prefix": "Mrs.",
"credential": "RDH-EA, OMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-02",
"last_updated": "2014-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "ID",
"license": "DH-0356-EA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.