Healthcare Provider Details

I. General information

NPI: 1669007712
Provider Name (Legal Business Name): STEVEN LEE HENGEN JR. DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18301 N 79TH AVE STE G185
GLENDALE AZ
85308-6093
US

IV. Provider business mailing address

18301 N 79TH AVE STE G185
GLENDALE AZ
85308-6093
US

V. Phone/Fax

Practice location:
  • Phone: 623-931-9197
  • Fax: 623-937-4385
Mailing address:
  • Phone: 623-931-9197
  • Fax: 623-937-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD011579
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: