NPIMap

Individual provider Active NPI

John E Hickory, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Wilmington, NC
National Provider Identifier
1912200031
Registry record updated Dec 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
06633 Issued in IA
Practice address
412 Ann St
Wilmington, NC 28401-4662
Phone
(910) 763-8163
Fax
(910) 763-4505
NPI assigned
Dec 11, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 06633 IA Primary

Addresses

Primary practice location

412 Ann St
Wilmington, NC 28401-4662

Mailing address

412 Ann St
Wilmington, NC 28401-4662
Phone (910) 763-8163

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Medical Center, Inc. Past Accepting new patients
Gundersen Clinic LTD Past Accepting new patients
Gundersen Clinic LTD Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1292025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292025600000",
    "number": "1912200031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 ANN ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284014662",
            "telephone_number": "910-763-8163",
            "fax_number": "910-763-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 ANN ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284014662",
            "telephone_number": "910-763-8163",
            "fax_number": "910-763-4505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKORY",
        "first_name": "JOHN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-12-11",
        "last_updated": "2010-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IA",
            "license": "06633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2010; 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.