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NPI Code Detail

MEDICARE: DR. WILMER HECHANOVA DDS

MEDICARE: DR. WILMER HECHANOVA DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry29695CA

General Provider Information

NPI Number : 1518944578
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILMER HECHANOVA DDS
Provider Business Mailing Address
First Line : PO BOX 188
Second Line :
City : SMITH RIVER
State : CA
Zip : 95567-0188
Country : US
Telephone Number : 707-218-7282
Fax Number : 707-487-0188
Provider Business Practice Location Address
First Line : 501 N INDIAN RD
Second Line :
City : SMITH RIVER
State : CA
Zip : 95567-9509
Country : US
Telephone Number : 707-825-4042
Fax Number : 707-825-5045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 07/08/2007

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