Provider Demographics
NPI:1821404328
Name:HENTGES, ZACHARY (DMD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:HENTGES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 E BROADWAY RD UNIT 67
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-1567
Mailing Address - Country:US
Mailing Address - Phone:480-313-4143
Mailing Address - Fax:
Practice Address - Street 1:7440 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5529
Practice Address - Country:US
Practice Address - Phone:480-339-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist