Healthcare Provider Details

I. General information

NPI: 1942133590
Provider Name (Legal Business Name): JOSEPH HENEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5916 LAKE MICHIGAN DR
ALLENDALE MI
49401-8111
US

IV. Provider business mailing address

20970 MAYBURY PARK DR
NORTHVILLE MI
48167-0149
US

V. Phone/Fax

Practice location:
  • Phone: 616-895-7400
  • Fax:
Mailing address:
  • Phone: 248-756-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603105
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: