Thomas Randal Hicks, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7362 Issued in OR

Practice address

13305 NW Cornell Rd Ste a
Portland, OR 97229-5987

Phone

(503) 644-5433

Fax

(503) 644-5436

NPI assigned

Dec 8, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Thomas Randal Hicks Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 10, 2015 through Dec 10, 2027

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.

• Lifesmile Dental Group

  • General Practice Dentistry
  • Portland, OR
  • NPI 1144416959
  NPD (past) Authorized official

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675468800000",
    "number": "1922168335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13305 NW CORNELL RD STE A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295987",
            "telephone_number": "503-644-5433",
            "fax_number": "503-644-5436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13305 NW CORNELL RD STE A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295987",
            "telephone_number": "503-644-5433",
            "fax_number": "503-644-5436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "THOMAS",
        "middle_name": "RANDAL",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2023-02-04",
        "certification_date": "2023-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922168335",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THOMAS",
            "last_name": "HICKS",
            "middle_name": "RANDAL",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Matthew Raymond Hicks, ND
• Matthew Robert Hicks, DMD
• Sabrina Hicks, LAC
• Saffiya N Hicks
• Taheerah Hicks
• Elaine Hidalgo
• Ignacio Hidalgo
• Katy Hidalgo
• Mark Angel Hidalgo
• Nina J Hidalgo, PH.D.

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.