Provider Demographics
NPI:1740572932
Name:HEDGECOCK DENTAL, PLLC
Entity Type:Organization
Organization Name:HEDGECOCK DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HEDGECOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-892-2273
Mailing Address - Street 1:5920 WEST WILLIAM CANNON DRIVE
Mailing Address - Street 2:BLDG. 6 SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749
Mailing Address - Country:US
Mailing Address - Phone:512-892-2273
Mailing Address - Fax:512-900-2866
Practice Address - Street 1:5920 W WILLIAM CANNON DR STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1902
Practice Address - Country:US
Practice Address - Phone:512-892-2273
Practice Address - Fax:512-900-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261591223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty