Provider Demographics
NPI:1770597106
Name:HEGDE, MEGHA SUBBARAO (DMD)
Entity type:Individual
Prefix:DR
First Name:MEGHA
Middle Name:SUBBARAO
Last Name:HEGDE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:123 GOLF TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6363
Mailing Address - Country:US
Mailing Address - Phone:404-918-0086
Mailing Address - Fax:770-389-9729
Practice Address - Street 1:2339 LAKE HARBIN RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1905
Practice Address - Country:US
Practice Address - Phone:770-961-1222
Practice Address - Fax:770-961-6121
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1784065OtherUNITED CONCORDIA
GA100561OtherAVESIS
GA9181248OtherDORAL