Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 31394 | TX |
NPI | 1003283458 |
---|---|
Provider Name | Dr. Andrew D Henning |
First Address | Great Lakes, IL 60088-3155 |
Second Address | Great Lakes, IL 60088-3155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2015 |
Last Update Date | 01/12/2015 |