Provider Demographics
NPI:1023627015
Name:HEGDE, RAMYA
Entity type:Individual
Prefix:
First Name:RAMYA
Middle Name:
Last Name:HEGDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 W HERON ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6225
Mailing Address - Country:US
Mailing Address - Phone:360-532-5437
Mailing Address - Fax:
Practice Address - Street 1:818 MIDDLE CREEK RD STE 1
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5017
Practice Address - Country:US
Practice Address - Phone:865-622-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61078397122300000X
TN12744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12744OtherTENNESSEE STATE DENTAL LICENSE