Provider Demographics
NPI:1568549004
Name:HENNESSEY, ANNE NORENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:NORENE
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9219 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-9150
Mailing Address - Country:US
Mailing Address - Phone:319-266-1906
Mailing Address - Fax:319-266-1411
Practice Address - Street 1:9219 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-9150
Practice Address - Country:US
Practice Address - Phone:319-266-1906
Practice Address - Fax:319-266-1411
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0120766Medicaid