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General NPI Number Information
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NPI Number | 1033576590
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Entity Type | Individual
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Provider Name | KIRANKUMAR HEGDE
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Gender | Male
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 708 PALUXY RD SUITE B
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City | GRANBURY
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State | TX
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Zip | 76048-2396
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Country | US
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Telephone | 817-573-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 CITRINE PASS 1-136
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City | HALTOM CITY
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State | TX
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Zip | 76137-7073
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Country | US
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Telephone | 508-308-1165
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 31650
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License Number State | TX
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