Healthcare Provider Details

I. General information

NPI: 1952476269
Provider Name (Legal Business Name): HENNIG WOODBURY & HOWARD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 FASHION SQUARE BOULEVARD
SAGINAW MI
48603-1249
US

IV. Provider business mailing address

4350 FASHION SQUARE BOULEVARD
SAGINAW MI
48603-1249
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-7128
  • Fax: 989-799-3895
Mailing address:
  • Phone: 989-799-7128
  • Fax: 989-799-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE B HENNIG
Title or Position: PRESIDENT
Credential: DDS MS
Phone: 989-799-7128