Provider Demographics
NPI:1689695587
Name:HEDE, DIANA D (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:D
Last Name:HEDE
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 1:960 MAIN ST
Mailing Address - Street 2:HARTFORD PUBLIC SCHOOLS HEALTH SERVICES
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-1224
Mailing Address - Country:US
Mailing Address - Phone:860-695-8760
Mailing Address - Fax:860-722-8095
Practice Address - Street 1:860 MAIN ST
Practice Address - Street 2:HEALTH SRVCS
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103
Practice Address - Country:US
Practice Address - Phone:860-695-8760
Practice Address - Fax:860-722-8095
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT71031223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health