Provider Demographics
NPI:1639375900
Name:HENNESSY, KAREN THERESE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:THERESE
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:MN
Mailing Address - Zip Code:55952-1209
Mailing Address - Country:US
Mailing Address - Phone:507-523-3227
Mailing Address - Fax:
Practice Address - Street 1:1647 16TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1650
Practice Address - Country:US
Practice Address - Phone:507-282-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH5755124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist