Provider Demographics
NPI:1912332396
Name:HEGG, JAMES R (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:HEGG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2295
Mailing Address - Country:US
Mailing Address - Phone:860-828-0868
Mailing Address - Fax:860-828-1023
Practice Address - Street 1:925 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-2295
Practice Address - Country:US
Practice Address - Phone:860-828-0868
Practice Address - Fax:860-828-1023
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice