Healthcare Provider Details

I. General information

NPI: 1285717900
Provider Name (Legal Business Name): MARK A HENKE DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 NW ROLLING GREEN DRIVE
CORVALLIS OR
97330
US

IV. Provider business mailing address

2605 NW ROLLING GREEN DRIVE
CORVALLIS OR
97330
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-0082
  • Fax: 541-757-7325
Mailing address:
  • Phone: 541-757-0082
  • Fax: 541-757-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MARK ADAM HENKE
Title or Position: DOCTOR OWNER
Credential: DMD
Phone: 541-757-0082