Provider Demographics
NPI:1003848201
Name:HEDGECOE, DAVID JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOEL
Last Name:HEDGECOE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 EXECUTIVE PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5124
Mailing Address - Country:US
Mailing Address - Phone:910-484-6145
Mailing Address - Fax:910-484-2552
Practice Address - Street 1:600 EXECUTIVE PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5124
Practice Address - Country:US
Practice Address - Phone:910-484-6145
Practice Address - Fax:910-484-2552
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice