Healthcare Provider Details

I. General information

NPI: 1609796556
Provider Name (Legal Business Name): JUSTINE HENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PETERBORO ST
DETROIT MI
48201-2722
US

IV. Provider business mailing address

5500 TRUMBULL ST APT 415
DETROIT MI
48208-1746
US

V. Phone/Fax

Practice location:
  • Phone: 313-251-2794
  • Fax:
Mailing address:
  • Phone: 313-797-8980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: