Provider Demographics
NPI:1013130251
Name:MICHAEL J HEDMOND DDS PLLC
Entity type:Organization
Organization Name:MICHAEL J HEDMOND DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-723-1230
Mailing Address - Street 1:332 PENCO RD
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3813
Mailing Address - Country:US
Mailing Address - Phone:304-723-1230
Mailing Address - Fax:
Practice Address - Street 1:332 PENCO RD
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3813
Practice Address - Country:US
Practice Address - Phone:304-723-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty