Provider Demographics
NPI:1891860177
Name:HENGEVELD, ROBERT ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANDREW
Last Name:HENGEVELD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:ANDREW
Other - Last Name:HENGEVELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1480 RATZER RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2430
Mailing Address - Country:US
Mailing Address - Phone:973-595-7744
Mailing Address - Fax:973-595-7225
Practice Address - Street 1:1480 RATZER RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2430
Practice Address - Country:US
Practice Address - Phone:973-595-7744
Practice Address - Fax:973-595-7225
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D100935000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3150909Medicaid