Provider Demographics
NPI:1265630677
Name:HEGMANN, WILLIAM TODD (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TODD
Last Name:HEGMANN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4410 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3015
Mailing Address - Country:US
Mailing Address - Phone:903-794-9974
Mailing Address - Fax:903-793-6067
Practice Address - Street 1:4410 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3015
Practice Address - Country:US
Practice Address - Phone:903-794-9974
Practice Address - Fax:903-793-6067
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR39071223G0001X
WV37161223S0112X
TX285581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery