Provider Demographics
NPI:1023006236
Name:HENLEY, KENNETH E (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:HENLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 S 168TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2079
Mailing Address - Country:US
Mailing Address - Phone:402-778-0218
Mailing Address - Fax:402-330-3718
Practice Address - Street 1:2909 S 168TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2079
Practice Address - Country:US
Practice Address - Phone:402-778-0218
Practice Address - Fax:402-330-3718
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice