Provider Demographics
NPI:1407309784
Name:HENSELER ORTHODONTICS
Entity Type:Organization
Organization Name:HENSELER ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HENSELER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:651-739-1555
Mailing Address - Street 1:1000 RADIO DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8409
Mailing Address - Country:US
Mailing Address - Phone:651-739-1555
Mailing Address - Fax:651-739-1556
Practice Address - Street 1:1000 RADIO DR
Practice Address - Street 2:SUITE 220
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8409
Practice Address - Country:US
Practice Address - Phone:651-739-1555
Practice Address - Fax:651-739-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN108041223X0400X
MND122651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty