Provider Demographics
NPI:1952476269
Name:HENNIG WOODBURY & HOWARD PC
Entity Type:Organization
Organization Name:HENNIG WOODBURY & HOWARD PC
Other - Org Name:HENNIG & WOODBURY PC & SPENGLER & HENNIG PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HENNIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:989-799-7128
Mailing Address - Street 1:4350 FASHION SQUARE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1249
Mailing Address - Country:US
Mailing Address - Phone:989-799-7128
Mailing Address - Fax:989-799-3895
Practice Address - Street 1:4350 FASHION SQUARE BOULEVARD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1249
Practice Address - Country:US
Practice Address - Phone:989-799-7128
Practice Address - Fax:989-799-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G36100Medicare ID - Type Unspecified