Provider Demographics
NPI:1487860094
Name:HEGDE, POOJA K (DDS)
Entity Type:Individual
Prefix:DR
First Name:POOJA
Middle Name:K
Last Name:HEGDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 SALVIO ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2534
Mailing Address - Country:US
Mailing Address - Phone:925-687-6200
Mailing Address - Fax:925-687-6200
Practice Address - Street 1:2903 SALVIO ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2534
Practice Address - Country:US
Practice Address - Phone:925-687-6200
Practice Address - Fax:925-687-6200
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice