Provider Demographics
NPI:1164641429
Name:HENNIGAR, WILLIAM GRANT JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GRANT
Last Name:HENNIGAR
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:2025 WHITEHAVEN RD
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-0574
Mailing Address - Country:US
Mailing Address - Phone:716-773-1990
Mailing Address - Fax:
Practice Address - Street 1:2025 WHITEHAVEN RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072
Practice Address - Country:US
Practice Address - Phone:716-773-1990
Practice Address - Fax:716-773-2280
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00607869Medicaid