Provider Demographics
NPI:1336483759
Name:WILLIAM TODD HEGMANN DDS, MS
Entity Type:Organization
Organization Name:WILLIAM TODD HEGMANN DDS, MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HEGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:903-701-1052
Mailing Address - Street 1:1015 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-2745
Mailing Address - Country:US
Mailing Address - Phone:870-773-3119
Mailing Address - Fax:870-772-7347
Practice Address - Street 1:1015 E 35TH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-2745
Practice Address - Country:US
Practice Address - Phone:870-773-3119
Practice Address - Fax:870-772-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR39071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty