Provider Demographics
NPI:1215013966
Name:HEGGLAND, KARL L H (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:L H
Last Name:HEGGLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:KARL
Other - Middle Name:L
Other - Last Name:HICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 4998
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443
Mailing Address - Country:US
Mailing Address - Phone:970-668-1314
Mailing Address - Fax:970-668-1057
Practice Address - Street 1:975 N TEN MILE DR
Practice Address - Street 2:SUITE E-11
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-1314
Practice Address - Fax:970-668-1057
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87551223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57652325Medicaid
CO57652325Medicaid
CO547458Medicare ID - Type Unspecified