Healthcare Provider Details

I. General information

NPI: 1730815556
Provider Name (Legal Business Name): KARA HEGWOOD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W ANDERSON LN STE 418
AUSTIN TX
78757-1304
US

IV. Provider business mailing address

3808 WOODCHESTER LN
AUSTIN TX
78727-2934
US

V. Phone/Fax

Practice location:
  • Phone: 512-334-9894
  • Fax:
Mailing address:
  • Phone: 817-304-4713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38420
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: