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General NPI Number Information
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NPI Number | 1407309784
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Entity Type | Organization
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Legal Business Name | HENSELER ORTHODONTICS
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 1000 RADIO DR SUITE 220
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City | WOODBURY
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State | MN
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Zip | 55125-8409
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Country | US
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Telephone | 651-739-1555
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Fax | 651-739-1556
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Provider Business Mailing Address
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Address Line | 1000 RADIO DR SUITE 220
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City | WOODBURY
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State | MN
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Zip | 55125-8409
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Country | US
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Telephone | 651-739-1555
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Fax | 651-739-1556
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Authorized Official
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Title or Position | DDS ORTHODONTIST
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Name | STEVEN JOHN HENSELER
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Credential | DDS, PA
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Telephone | 651-739-1555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 10804
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D12265
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License Number State | MN
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