Provider Demographics
NPI:1093854408
Name:HENNING, SCOTT CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CARL
Last Name:HENNING
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 1:14570 MONO WAY
Mailing Address - Street 2:SUITE I
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:209-536-1954
Mailing Address - Fax:209-536-6554
Practice Address - Street 1:14570 MONO WAY
Practice Address - Street 2:SUITE I
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-536-1954
Practice Address - Fax:209-536-6554
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist