Provider Demographics
NPI:1497167316
Name:HENZLER, JOSHUA
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:HENZLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-1706
Mailing Address - Country:US
Mailing Address - Phone:570-538-5533
Mailing Address - Fax:
Practice Address - Street 1:151 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATSONTOWN
Practice Address - State:PA
Practice Address - Zip Code:17777-1706
Practice Address - Country:US
Practice Address - Phone:570-538-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist