Healthcare Provider Details

I. General information

NPI: 1669566592
Provider Name (Legal Business Name): WILLIAM H HEGGEN III DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 N MO PAC SUITE 250
AUSTIN TX
78759
US

IV. Provider business mailing address

7800 N MO PAC SUITE 250
AUSTIN TX
78759
US

V. Phone/Fax

Practice location:
  • Phone: 254-774-9552
  • Fax: 254-774-9464
Mailing address:
  • Phone: 512-345-9779
  • Fax: 512-345-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10812
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: