Healthcare Provider Details

I. General information

NPI: 1710478110
Provider Name (Legal Business Name): ANDREW W HENRITZE DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 BRAMBLETON AVE
ROANOKE VA
24018-3611
US

IV. Provider business mailing address

PO BOX 52942
PHOENIX AZ
85072-2942
US

V. Phone/Fax

Practice location:
  • Phone: 330-951-9153
  • Fax: 888-817-9032
Mailing address:
  • Phone: 330-951-9153
  • Fax: 888-817-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number041008724
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA HAWKINS HARRIS
Title or Position: ACCOUNTS RECEIVABLE ANALYST
Credential:
Phone: 540-776-6555