Healthcare Provider Details

I. General information

NPI: 1235239609
Provider Name (Legal Business Name): FREDERICK G HEGEDUS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CENTRAL PARK SOUTH 3A
NEW YORK NY
10019
US

IV. Provider business mailing address

30 CENTRAL PARK SOUTH 3A
NEW YORK NY
10019
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-2993
  • Fax:
Mailing address:
  • Phone: 212-759-2993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number049697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: