Healthcare Provider Details

I. General information

NPI: 1417065624
Provider Name (Legal Business Name): ROBERT SOWELL HEGLER SR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S ASHE ST
KERSHAW SC
29067
US

IV. Provider business mailing address

104 S ASHE ST
KERSHAW SC
29067
US

V. Phone/Fax

Practice location:
  • Phone: 803-475-2644
  • Fax: 803-475-2234
Mailing address:
  • Phone: 803-475-2644
  • Fax: 803-475-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2110
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: