Healthcare Provider Details

I. General information

NPI: 1215013966
Provider Name (Legal Business Name): KARL L H HEGGLAND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KARL L HICKEY DDS

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 N TEN MILE DR SUITE E-11
FRISCO CO
80443
US

IV. Provider business mailing address

PO BOX 4998
FRISCO CO
80443
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-1314
  • Fax: 970-668-1057
Mailing address:
  • Phone: 970-668-1314
  • Fax: 970-668-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8755
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8755
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: