Provider Demographics
NPI:1407120660
Name:HENNES, THOMAS EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:HENNES
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 1:210 OAK BAY ST
Mailing Address - Street 2:UNIT 1201
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-6915
Mailing Address - Country:US
Mailing Address - Phone:361-729-5757
Mailing Address - Fax:
Practice Address - Street 1:210 OAK BAY ST
Practice Address - Street 2:UNIT 1201
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-6915
Practice Address - Country:US
Practice Address - Phone:361-729-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4001788-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist