Provider Demographics
NPI:1316189632
Name:HEGARDT, JOHN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:HEGARDT
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 1:2700 BELLFLOWER BLVD.
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815
Mailing Address - Country:US
Mailing Address - Phone:562-982-1552
Mailing Address - Fax:562-425-3412
Practice Address - Street 1:2700 BELLFLOWER BLVD.
Practice Address - Street 2:SUITE 206
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815
Practice Address - Country:US
Practice Address - Phone:562-982-1552
Practice Address - Fax:562-425-3412
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist