Hickman, Leland
Hickman, Leland is an individual health care provider with primary practice located at 809 W Detweiller Dr Suite 805A, Peoria IL 61615-2149. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Hickman, Leland can be contacted via phone (309) 692-1320.Contact Information
Primary practice address
809 W Detweiller Dr Suite 805A
Peoria IL 61615-2149
Phone: (309) 692-1320
Fax: (309) 692-1355
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | Illinois |
Profile Details
| NPI number | 1306984588 |
|---|---|
| LBN Legal business name | Hickman, Leland |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 1st, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306984588 | NPPES |
| Illinois | MEDICAID | 1002205 |
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