Jordan King Alexis Hicks, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DEN4543 Issued in ME

Practice address

612 Brighton Ave
Portland, ME 04102-2359

Phone

(207) 772-4359

NPI assigned

Jun 21, 2017

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michael Bufo DMD LLC

  dba Windham Dental Associates

  • General Practice Dentistry
  • Windham, ME
  • NPI 1700153483
  NPD (past)

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1932629953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 BRIGHTON AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 BRIGHTON AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022359",
            "telephone_number": "207-772-4359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 Commons Ave",
            "address_purpose": "LOCATION",
            "city": "Windham",
            "state": "ME",
            "postal_code": "040625554",
            "country_code": "US",
            "telephone_number": "207-893-2001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKS",
        "first_name": "JORDAN",
        "middle_name": "KING ALEXIS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-21",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ME",
            "license": "DEN4543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel J Hibbs, LCSW
• Jennifer L Hibbs, LCPC-CC
• Alan Joseph Hickey, DMD
• Emily Grace Hickey
• Anne Cuttler Hicks, M.D.
• Hidden Glade Counseling, LLC
• Erica Hidu, M.D.
• Ryan Joseph Hiebert, DPM
• Tara K Hieger, NP
• Andrea B Higgins, MD

• Dentist in Portland, ME
• Providers in Portland, ME by specialty
• Dentist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.