Active NPI
Clayton Gray Hicks Sr., DMD
- Pediatric Dentistry
- JB Andrews, MD
National Provider Identifier
1710972898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 10471
- Practice address
- 1060 W Perimeter Rd
JB Andrews, MD 20762-6602 - Phone
- (240) 857-5029
- NPI assigned
- Sep 15, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3693 | SC | |
| Pediatric Dentistry | 1223P0221X | 10471 | SC | Primary |
Addresses
Primary practice location
1060 W Perimeter Rd
JB Andrews, MD 20762-6602
Mailing address
1060 W Perimeter Rd
JB Andrews, MD 20762-6602
Phone (240) 857-5029
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 |
|---|---|---|---|
| 3693 | SC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782432000000",
"number": "1710972898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1060 W PERIMETER RD",
"city": "JB ANDREWS",
"state": "MD",
"postal_code": "207626602",
"telephone_number": "240-857-5029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1060 W PERIMETER RD",
"city": "JB ANDREWS",
"state": "MD",
"postal_code": "207626602",
"telephone_number": "240-857-5029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "CLAYTON",
"middle_name": "GRAY",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-15",
"last_updated": "2026-06-26",
"certification_date": "2026-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "3693",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "SC",
"license": "10471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in JB Andrews, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.