Healthcare Provider Details

I. General information

NPI: 1558046052
Provider Name (Legal Business Name): SANCHITH HEGDE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 GASTON AVE # 159A
DALLAS TX
75246-2013
US

IV. Provider business mailing address

3302 GASTON AVE # 159A
DALLAS TX
75246-2013
US

V. Phone/Fax

Practice location:
  • Phone: 760-815-9393
  • Fax: 214-874-4527
Mailing address:
  • Phone: 760-815-9393
  • Fax: 214-874-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number40114
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: