DR. JORDAN KING ALEXIS HICKS (NPI# 1932629953) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932629953 |
| Entity Type | Individual |
| Full Name | DR. JORDAN KING ALEXIS HICKS |
| Credential | DDS |
| Practice Address |
612 Brighton Ave Portland ME 04102-2359 |
| Practice Telephone | 2077724359 |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | DEN4543 | ME | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4 Commons Ave, Windham, ME 040625554 | 2078932001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770133167 | Jordan Hicks | Behavioral Analyst | 23842 Hawthorne Blvd Ste 100&101, Torrance, CA 90505-5929 | 2019-09-17 |
| 1295395069 | Jordan Hicks | Case Manager/Care Coordinator | 3100 E 45th St Ste 314, Cleveland, OH 44127-1095 | 2019-06-14 |
| 1477020782 | Jordan Hicks | Pharmacy | 100 Outlet Pointe Blvd, Columbia, SC 29210-5669 | 2018-10-25 |
| 1356639199 | Jordan P Hicks | Physical Therapist | 4230 Harding Pike Ste 400, Nashville, TN 37205-4900 | 2011-07-14 |
| Street Address |
612 BRIGHTON AVE |
| City | PORTLAND |
| State | ME |
| Zip Code | 04102-2359 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497722896 | Jeffrey Bruce Finegold | Dentist | 612 Brighton Ave, Portland, ME 04102-2359 | 2006-03-03 |
| 1013447234 | Alex Kerbaugh | Dentist | 612 Brighton Ave, Portland, ME 04102-2359 | 2017-06-20 |
| 1932329943 | Periodontal Associates | Dentist | 612 Brighton Ave, Portland, ME 04102-2359 | 2007-05-01 |
| 1114085255 | Stephen Gannett Morse | Dentist | 612 Brighton Ave, Portland, ME 04102-2359 | 2006-12-04 |
| 1669530713 | George David Gordon | Dentist | 612 Brighton Ave, Portland, ME 04102-2359 | 2006-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720602964 | Ci Yen Joanna Man | Student in an Organized Health Care Education/Training Program | 190 Park Ave., Portland, ME 04102 | 2020-06-03 |
| 1841811338 | Abby Zarotny Sahagian | Nurse Anesthetist, Certified Registered | Mmc Anesthesia and Perioperative Medicine, 22 Bramhall St, Portland, ME 04102 | 2020-05-06 |
| 1124656863 | Zachary Bernard Tillett | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall St., Portland, ME 04102 | 2020-03-30 |
| 1215564323 | Joshua Allen Swenson | Student in an Organized Health Care Education/Training Program | 33 Bramhall St, Portland, ME 04102 | 2020-03-26 |
| 1740776434 | Rishi Phakey | Dentist | Community Dental, 190 Park Ave, Portland, ME 04102 | 2018-07-05 |
| 1982192571 | Jessica Thomas | Doula | 619 Brighton Ave #101, Rosemont Wellness Center, Portland, ME 04102 | 2018-04-29 |
| 1699270744 | Shane D Kirkegaard | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall Street, Portland, ME 04102 | 2018-03-29 |
| 1144752494 | Al-shawk Home Healthcare, LLC | Technician | 640 Brighton Ave Ste 8, Portland, ME 04102 | 2017-03-28 |
| 1376074674 | Samuel B Potter | Emergency Medicine | Maine Medical Center, 22 Bramhall Street, Portland, ME 04102 | 2017-03-27 |
| 1043767536 | Kevin De Ruiter | Social Worker | 129 Pine St Apt 6, Portland, ME 04102 | 2016-09-01 |
| Find all providers in zip 04102 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598366064 | Felipe Gregorio Flores | Dentist | 107 Shorecliff Dr, Portland, TX 78374-1459 | 2020-11-02 |
| 1972117588 | Medical Teams International | Dentist | 14150 Sw Milton Ct, Portland, OR 97224-8024 | 2020-09-01 |
| 1255975561 | Michigan Sleep Solutions LLC | Dentist | 8037 Abbey Rd., Portland, MI 48875-9774 | 2019-10-30 |
| 1073162699 | Ryan Douglas Mccormick | Dentist | 3620 Se Powell Blvd Ste 200, Portland, OR 97202-1880 | 2019-09-06 |
| 1255989497 | Owen Ritter Lund | Dentist | 4224 Ne Halsey St Ste 330, Portland, OR 97213-1568 | 2019-08-30 |
| 1023663119 | Xiaochen Zhou | Dentist | 2824 Ne Wasco St Ste 200, Portland, OR 97232-1772 | 2019-08-06 |
| 1598223919 | Portland Modern Dentistry | Dentist | 5175 Ne Martin Luther King Blvd Ste 110, Portland, OR 97211-3233 | 2019-03-05 |
| 1922571942 | Rashmi, LLC | Dentist | 553 Portland Cobalt Rd Unit 1, Portland, CT 06480-1968 | 2019-01-03 |
| 1053891051 | Waleed Almulla | Dentist | 8401 Ne Halsey St Ste 102, Portland, OR 97220-5670 | 2018-08-19 |
| 1558848333 | Kelsey Mcevoy | Dentist | 11805 Nw Cedar Falls Dr Ste 101, Portland, OR 97229-2780 | 2018-07-24 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.