Healthcare Provider Details

I. General information

NPI: 1598996852
Provider Name (Legal Business Name): RASHMI HEGDE DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N TARRANT PKWY
KELLER TX
76248-5693
US

IV. Provider business mailing address

333 BEECHWOOD LN
COPPELL TX
75019-5307
US

V. Phone/Fax

Practice location:
  • Phone: 817-854-1533
  • Fax:
Mailing address:
  • Phone: 205-383-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number24820
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: