Provider Demographics
NPI:1760692149
Name:HEDLUND, RICARD W (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICARD
Middle Name:W
Last Name:HEDLUND
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 1:1742 MOUNT VERNON RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4251
Mailing Address - Country:US
Mailing Address - Phone:770-399-6799
Mailing Address - Fax:770-399-5699
Practice Address - Street 1:1742 MOUNT VERNON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4251
Practice Address - Country:US
Practice Address - Phone:770-399-6799
Practice Address - Fax:770-399-5699
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0111371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice