Healthcare Provider Details

I. General information

NPI: 1932168366
Provider Name (Legal Business Name): WILLIAM HENDERSHOT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1977 WHITE OAK LN
INTERLOCHEN MI
49643-9464
US

IV. Provider business mailing address

1977 WHITE OAK LN
INTERLOCHEN MI
49643-9464
US

V. Phone/Fax

Practice location:
  • Phone: 231-276-6877
  • Fax: 231-276-6903
Mailing address:
  • Phone: 231-276-6877
  • Fax: 231-276-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number158190
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: