MEDICARE: ANTHONY BRENT HENEGAR DDS

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	18083	TX

General Provider Information

NPI Number	:	1477586410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY BRENT HENEGAR DDS

Provider Business Mailing Address
First Line	:	825 W ROYAL LN STE 250
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-3901
Country	:	US
Telephone Number	:	214-484-3494
Fax Number	:	214-484-3153

Provider Business Practice Location Address
First Line	:	825 W ROYAL LN STE 250
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-3901
Country	:	US
Telephone Number	:	214-484-3494
Fax Number	:	214-484-3153

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	10/28/2024

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