Provider Demographics
NPI:1528183316
Name:HENKEN, EDMOND HERBERT (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:HERBERT
Last Name:HENKEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 PUERTA DEL SOL
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6343
Mailing Address - Country:US
Mailing Address - Phone:949-661-3336
Mailing Address - Fax:949-366-0094
Practice Address - Street 1:1171 PUERTA DEL SOL
Practice Address - Street 2:SUITE B
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6343
Practice Address - Country:US
Practice Address - Phone:949-661-3336
Practice Address - Fax:949-366-0094
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics