Provider Demographics
NPI:1104927367
Name:HEGDE, SANDHYA (DDS)
Entity type:Individual
Prefix:
First Name:SANDHYA
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 1:8899 UNIVERSITY CENTER LN STE 190
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1035
Mailing Address - Country:US
Mailing Address - Phone:858-546-0100
Mailing Address - Fax:858-546-0495
Practice Address - Street 1:4424 BONITA RD
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1423
Practice Address - Country:US
Practice Address - Phone:619-479-8703
Practice Address - Fax:619-479-4115
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist