Healthcare Provider Details

I. General information

NPI: 1104927367
Provider Name (Legal Business Name): SANDHYA HEGDE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4424 BONITA RD
BONITA CA
91902-1423
US

IV. Provider business mailing address

8899 UNIVERSITY CENTER LN STE 190
SAN DIEGO CA
92122-1035
US

V. Phone/Fax

Practice location:
  • Phone: 619-479-8703
  • Fax: 619-479-4115
Mailing address:
  • Phone: 858-546-0100
  • Fax: 858-546-0495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: