Katherine Valentine Hicks, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

8840 Issued in AZ

Practice address

5200 E Farness Dr.
Suite # 102
Tucson, AZ 85712

Phone

(520) 323-3866

Fax

(520) 372-2754

NPI assigned

Jun 18, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ms. Katherine Valentine Shadegg Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shadow Ridge Dental

  • General Practice Dentistry
  • Elkhorn, NE
  • NPI 1073811014
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1639374838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 E FARNESS DR.",
            "address_2": "SUITE # 102",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85712",
            "telephone_number": "520-323-3866",
            "fax_number": "520-372-2754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 E FARNESS DR.",
            "address_2": "SUITE # 102",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85712",
            "telephone_number": "520-323-3866",
            "fax_number": "520-372-2754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "KATHERINE",
        "middle_name": "VALENTINE",
        "name_prefix": "Mrs.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-18",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NE",
            "license": "6705",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "8840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "SHADEGG",
            "middle_name": "VALENTINE",
            "prefix": "MS.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Trennon Hickey, COTA
• Maria Carmen Hickle
• Brenetta Hicks-Jones
• Austyn Hicks
• Cassandra Ann Hicks, PH.D.
• Morris A Hicks, DDS
• Rina Hicks
• Shelby Taylor Hicks
• Thomas H Hicks, MD
• Vicki T Hicks

• Dentist in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.