Provider Demographics
NPI:1982275582
Name:HEGDE, NAMRATHA ARVIND (DDS)
Entity Type:Individual
Prefix:
First Name:NAMRATHA ARVIND
Middle Name:
Last Name:HEGDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 CANTON RD NE APT 419
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7265
Mailing Address - Country:US
Mailing Address - Phone:920-378-8791
Mailing Address - Fax:
Practice Address - Street 1:820 CANTON RD NE APT 419
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7265
Practice Address - Country:US
Practice Address - Phone:920-378-8791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1224741223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program