MEDICARE: DR. DAVID R HENNINGTON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15326	TX

General Provider Information

NPI Number	:	1114921574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID R HENNINGTON DDS

Provider Business Mailing Address
First Line	:	2425 WILLIAMS DR
Second Line	:	STE E
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-3201
Country	:	US
Telephone Number	:	512-863-6888
Fax Number	:	512-869-8934

Provider Business Practice Location Address
First Line	:	2425 WILLIAMS DR
Second Line	:	STE E
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-3201
Country	:	US
Telephone Number	:	512-863-6888
Fax Number	:	512-869-8934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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