MEDICARE: DR. JAMES E HENNEFIELD

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	122300000X	Dentist	029509-1	NY

General Provider Information

NPI Number	:	1932379013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES E HENNEFIELD

Provider Business Mailing Address
First Line	:	4401 AVENUE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5725
Country	:	US
Telephone Number	:	718-451-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 AVENUE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5725
Country	:	US
Telephone Number	:	718-451-1888
Fax Number	:

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

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	03/05/2008

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