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General NPI Number Information
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NPI Number | 1528183316
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Entity Type | Individual
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Provider Name | EDMOND HERBERT HENKEN DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 1171 PUERTA DEL SOL SUITE B
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6343
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Country | US
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Telephone | 949-661-3336
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Fax | 949-366-0094
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Provider Business Mailing Address
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Address Line | 1171 PUERTA DEL SOL SUITE B
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6343
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Country | US
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Telephone | 949-661-3336
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Fax | 949-366-0094
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 32465
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License Number State | CA
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