Provider Demographics
NPI:1255313235
Name:HENKES, WILLARD HENRY (DDS,PS)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:HENRY
Last Name:HENKES
Suffix:
Gender:M
Credentials:DDS,PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 E 8TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6451
Mailing Address - Country:US
Mailing Address - Phone:360-457-8531
Mailing Address - Fax:360-457-4034
Practice Address - Street 1:824 E 8TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6451
Practice Address - Country:US
Practice Address - Phone:360-457-8531
Practice Address - Fax:360-457-4034
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA42191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice