Healthcare Provider Details

I. General information

NPI: 1912332396
Provider Name (Legal Business Name): JAMES R HEGG D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 FARMINGTON AVE
KENSINGTON CT
06037-2295
US

IV. Provider business mailing address

925 FARMINGTON AVE
KENSINGTON CT
06037-2295
US

V. Phone/Fax

Practice location:
  • Phone: 860-828-0868
  • Fax: 860-828-1023
Mailing address:
  • Phone: 860-828-0868
  • Fax: 860-828-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5431
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: