Healthcare Provider Details

I. General information

NPI: 1538474572
Provider Name (Legal Business Name): STEPHEN TURNER HEGGIE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2010
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 THOUSAND OAKS DR STE 110
SAN ANTONIO TX
78247-3557
US

IV. Provider business mailing address

3023 THOUSAND OAKS DR STE 110
SAN ANTONIO TX
78247-3557
US

V. Phone/Fax

Practice location:
  • Phone: 210-497-6700
  • Fax: 210-497-6706
Mailing address:
  • Phone: 210-497-6700
  • Fax: 210-497-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-4309
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0026288
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: