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Active NPI 1487262697 Individual Practitioner Female Practitioner

Dr. Mary Hickerson , DDS

Dentist - General Practice • Eglin Afb, FL

Professional Overview & Biography Verified Profile Summary

Dr. Mary Hickerson, DDS is a registered healthcare professional specializing in Dentist - General Practice in Eglin Afb, FL. Practice services are available at 307 BOATNER RD STE 114 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

307 Boatner Rd Ste 114

Eglin Afb, FL 325421302

Telephone 8508033801
Associated Practice Facility / Clinic
🏢 96th Medgrp-Eglin Facility NPI 1083012223

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Eglin Afb, FL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 15.0 Yrs
Regional Practice Density
16 Specialists

Practicing in Eglin Afb, FL (7473 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-04-30
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MT 19470

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Dentist

NUCC Taxonomy Code: 122300000X

State License FL DN28849

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.

Dentist

NUCC Taxonomy Code: 122300000X

State License MT 19470

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.

Dentist - General Practice

NUCC Taxonomy Code: 1223G0001X

State License TX 36313

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Unavailable
UNAVAILABLE

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
NPI 1114959459

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

19 Historical Events
📍
Updated Practice Location April 30, 2025

Registered at 307 BOATNER RD STE 114, EGLIN AFB, FL 325421302 (Tel: 8508033801)

📍
Updated Business Mailing Address April 30, 2025

Registered at 307 BOATNER RD STE 114, EGLIN AFB, FL 325421302

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 30, 2025

Dentist (License #DN28849 in FL)

📍
Updated Practice Location September 02, 2021

Registered at 7300 N PERIMETER RD, MALMSTROM AFB, MT 594026701 (Tel: 2088612356)

📍
Updated Business Mailing Address September 02, 2021

Registered at 7300 N PERIMETER RD, GREAT FALLS, MT 594026701

👤
Provider Name / Credentials Updated September 02, 2021

Recorded as MARY HICKERSON, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 02, 2021

Dentist (License #19470 in MT)

📍
Updated Practice Location May 20, 2021

Registered at 7300 N PERIMETER RD, GREAT FALLS, MT 594026701 (Tel: 2088612356)

📍
Updated Business Mailing Address May 20, 2021

Registered at 702 BIRCH ST, GREAT FALLS, MT 594058626

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 20, 2021

Dentist (License #36313 in TX)

📍
Updated Practice Location April 19, 2021

Registered at 202 2ND AVE S STE 203, GREAT FALLS, MT 594051831 (Tel: 2088612356)

📍
Updated Business Mailing Address April 19, 2021

Registered at 601 1ST AVE N, GREAT FALLS, MT 594012510 (Tel: 4067919267)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 19, 2021

Dentist (License #19470 in MT)

NPI Profile Active July 14, 2020

NPI status registered as active in NPPES database

📍
Updated Practice Location July 14, 2020

Registered at 6929 FIELDSTONE DR, SAN ANGELO, TX 769044168 (Tel: 2088612356)

📍
Updated Business Mailing Address July 14, 2020

Registered at 6929 FIELDSTONE DR, SAN ANGELO, TX 769044168 (Tel: 2088612356)

👤
Provider Name / Credentials Updated July 14, 2020

Recorded as MARY HICKERSON

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 14, 2020

Dentist (License #36313 in TX)

🟢
Initial NPI Registration & Enumeration July 14, 2020

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1487262697
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 14, 2020
Last Update: April 30, 2025
Sole Proprietor: No

Mailing Address

307 Boatner Rd Ste 114

Eglin Afb, FL 325421302

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.