Healthcare Provider Details

I. General information

NPI: 1639450372
Provider Name (Legal Business Name): MARK STEVEN HEGEMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 CHEVY CHASE DRIVE #B2
CHEVY CHASE MD
20815
US

IV. Provider business mailing address

4820 CHEVY CHASE DRIVE #B2
CHEVY CHASE MD
20815
US

V. Phone/Fax

Practice location:
  • Phone: 301-652-8200
  • Fax:
Mailing address:
  • Phone: 301-652-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10264
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: