| Organization Name: | LARRY HEGGERNESS SOCIAL PURPOSE PROFESSIONAL CORPORATION |
| NPI Number: | 1124365796 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LARRY K HEGGERNESS (PRESIDENT) |
| Mailing Address: | 6720 Fort Dent Way Ste 120 Tukwila |
| State: | WA US |
| Postal Code: | 981882580 |
| Phone Number: | 2062424121 |
| Fax Number: | 2062424113 |
| NPI Enumeration Date: | 01/15/2013 |
| NPI Last Update Date: | 01/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | DE00003686 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |