Provider Demographics
NPI:1164514816
Name:HENCH, MICHAEL D (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:HENCH
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 1:1181 CENTRAL BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2278
Mailing Address - Country:US
Mailing Address - Phone:925-634-6105
Mailing Address - Fax:925-634-7372
Practice Address - Street 1:1181 CENTRAL BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2278
Practice Address - Country:US
Practice Address - Phone:925-634-6105
Practice Address - Fax:925-634-7372
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA328481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice