Robert Sowell Hegler Sr., DMD
Individual provider Active NPI Dentist · Kershaw, SC
NPI 1417065624 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1417065624
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2110 (SC)
- Practice address
- 104 S Ashe St
Kershaw, SC 29067 - Phone
- (803) 475-2644
- Fax
- (803) 475-2234
- NPI assigned
- Aug 28, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160225001725 | SC | Order and Referring Only - Dentist |
9234434408 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2110 | SC | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2110 | SC | Yes |
Addresses
Primary practice location
104 S Ashe St
Kershaw, SC 29067
Mailing address
104 S Ashe St
Kershaw, SC 29067
Phone (803) 475-2644
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Z21101 | Medicaid | SC | |
| 841788 | Other | US ARMY UNITED CONCORDIA |
Other providers in Kershaw, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.