Provider Demographics
NPI:1306019385
Name:HENNESSY, MICHAEL P (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:HENNESSY
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 1:3027 FOREST HILL BLVD.
Mailing Address - Street 2:SUITE # A-3
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406
Mailing Address - Country:US
Mailing Address - Phone:561-433-4330
Mailing Address - Fax:
Practice Address - Street 1:3027 FOREST HILL BLVD
Practice Address - Street 2:SUITE # A-3
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5934
Practice Address - Country:US
Practice Address - Phone:561-433-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 169731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics