Provider Demographics
NPI:1225174857
Name:HENSCHEL, THOMAS R (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:HENSCHEL
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 1:12660 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4633
Mailing Address - Country:US
Mailing Address - Phone:262-796-1312
Mailing Address - Fax:262-796-1318
Practice Address - Street 1:12660 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4633
Practice Address - Country:US
Practice Address - Phone:262-796-1312
Practice Address - Fax:262-796-1318
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice