Healthcare Provider Details

I. General information

NPI: 1023024296
Provider Name (Legal Business Name): ROBERT HENNER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHERIDAN AVE
CONGERS NY
10920-2011
US

IV. Provider business mailing address

1 SHERIDAN AVE
CONGERS NY
10920-2011
US

V. Phone/Fax

Practice location:
  • Phone: 845-268-3828
  • Fax: 845-268-0279
Mailing address:
  • Phone: 845-268-3828
  • Fax: 845-268-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number026446
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN6823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: