Provider Demographics
NPI:1518944578
Name:HECHANOVA, WILMER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILMER
Middle Name:
Last Name:HECHANOVA
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:SMITH RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95567-0188
Mailing Address - Country:US
Mailing Address - Phone:707-218-7282
Mailing Address - Fax:707-487-0188
Practice Address - Street 1:501 N INDIAN RD
Practice Address - Street 2:
Practice Address - City:SMITH RIVER
Practice Address - State:CA
Practice Address - Zip Code:95567-9509
Practice Address - Country:US
Practice Address - Phone:707-825-4042
Practice Address - Fax:707-825-5045
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice