Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0401410987 | VA |
NPI | 1033217765 |
---|---|
Provider Name | Dr. Roger Hennigh |
First Address | Woodbridge, VA 22193-1469 |
Second Address | Woodbridge, VA 22193-1469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 09/11/2015 |