Provider Demographics
NPI:1811084767
Name:HENKE, DOUGLAS A (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:HENKE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:31410 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2563
Mailing Address - Country:US
Mailing Address - Phone:248-626-6656
Mailing Address - Fax:248-626-5023
Practice Address - Street 1:31410 NORTHWESTERN HWY
Practice Address - Street 2:SUITE E
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2563
Practice Address - Country:US
Practice Address - Phone:248-626-6656
Practice Address - Fax:248-626-5023
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI175671223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics