MEDICARE: DR. ANDREW HENNINGER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6629	AL

General Provider Information

NPI Number	:	1457910564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW HENNINGER DMD

Provider Business Mailing Address
First Line	:	2246 WINCHESTER RD NE STE 106
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35811-6801
Country	:	US
Telephone Number	:	256-859-8066
Fax Number	:	855-259-1075

Provider Business Practice Location Address
First Line	:	2246 WINCHESTER RD NE STE 106
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35811-6801
Country	:	US
Telephone Number	:	256-859-8066
Fax Number	:	855-259-1075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	06/12/2019

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