Provider Demographics
NPI:1407102999
Name:HEGGANNAVAR, SARIKA B
Entity Type:Individual
Prefix:DR
First Name:SARIKA
Middle Name:B
Last Name:HEGGANNAVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10412 PLAZA CENTRO
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6723
Mailing Address - Country:US
Mailing Address - Phone:561-237-5118
Mailing Address - Fax:
Practice Address - Street 1:800 E MERRITT ISLAND CSWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3514
Practice Address - Country:US
Practice Address - Phone:321-453-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist