Provider Demographics
NPI:1386043156
Name:HARISH HEGDE,D.D.S,INC
Entity Type:Organization
Organization Name:HARISH HEGDE,D.D.S,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-995-1222
Mailing Address - Street 1:9111 VALLEY VIEW ST
Mailing Address - Street 2:#106
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5800
Mailing Address - Country:US
Mailing Address - Phone:714-995-1222
Mailing Address - Fax:714-995-2873
Practice Address - Street 1:9111 VALLEY VIEW ST
Practice Address - Street 2:#106
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5800
Practice Address - Country:US
Practice Address - Phone:714-995-1222
Practice Address - Fax:714-995-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31061305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14161600028OtherDENTI-CAL