Provider Demographics
NPI:1699847517
Name:HENEHAN, BERNARD THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:THOMAS
Last Name:HENEHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000-2 N GAINES DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-1132
Mailing Address - Country:US
Mailing Address - Phone:660-885-6991
Mailing Address - Fax:660-885-3554
Practice Address - Street 1:2000 N GAINES DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-1132
Practice Address - Country:US
Practice Address - Phone:660-885-6991
Practice Address - Fax:660-885-3554
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice