MEDICARE: DAVID M HENINGER D.D.S.

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	D-1921	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D-1921	OTHER	ID	IDAHO DENTAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760406193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M HENINGER D.D.S.

Provider Business Mailing Address
First Line	:	3375 MERLIN DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7405
Country	:	US
Telephone Number	:	208-524-1700
Fax Number	:	208-524-1702

Provider Business Practice Location Address
First Line	:	3375 MERLIN DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7405
Country	:	US
Telephone Number	:	208-524-1700
Fax Number	:	208-524-1702

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	05/04/2009

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Directions to “ DAVID M HENINGER D.D.S.” Practice Location

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