Healthcare Provider Details

I. General information

NPI: 1740572932
Provider Name (Legal Business Name): HEDGECOCK DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 W WILLIAM CANNON DR STE 200
AUSTIN TX
78749-1902
US

IV. Provider business mailing address

5920 WEST WILLIAM CANNON DRIVE BLDG. 6 SUITE 200
AUSTIN TX
78749
US

V. Phone/Fax

Practice location:
  • Phone: 512-892-2273
  • Fax: 512-900-2866
Mailing address:
  • Phone: 512-892-2273
  • Fax: 512-900-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number26159
License Number StateTX

VIII. Authorized Official

Name: DR. BRANDON C HEDGECOCK
Title or Position: PRESIDENT
Credential: DDS
Phone: 512-892-2273