Provider Demographics
NPI:1922137066
Name:HEDRICK, DAVID ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:HEDRICK
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 1:5490 S WACO ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2654
Mailing Address - Country:US
Mailing Address - Phone:303-693-1851
Mailing Address - Fax:
Practice Address - Street 1:12357 E CORNELL AVE
Practice Address - Street 2:#10
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3323
Practice Address - Country:US
Practice Address - Phone:303-337-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD 104321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist