Provider Demographics
NPI:1033576590
Name:HEGDE, KIRANKUMAR
Entity Type:Individual
Prefix:
First Name:KIRANKUMAR
Middle Name:
Last Name:HEGDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 CITRINE PASS
Mailing Address - Street 2:1-136
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76137-7073
Mailing Address - Country:US
Mailing Address - Phone:508-308-1165
Mailing Address - Fax:
Practice Address - Street 1:708 PALUXY RD
Practice Address - Street 2:SUITE B
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2396
Practice Address - Country:US
Practice Address - Phone:817-573-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX316501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice