Provider Demographics
NPI:1932168366
Name:HENDERSHOT, WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HENDERSHOT
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 1:1977 WHITE OAK LN
Mailing Address - Street 2:
Mailing Address - City:INTERLOCHEN
Mailing Address - State:MI
Mailing Address - Zip Code:49643-9464
Mailing Address - Country:US
Mailing Address - Phone:231-276-6877
Mailing Address - Fax:231-276-6903
Practice Address - Street 1:1977 WHITE OAK LN
Practice Address - Street 2:
Practice Address - City:INTERLOCHEN
Practice Address - State:MI
Practice Address - Zip Code:49643-9464
Practice Address - Country:US
Practice Address - Phone:231-276-6877
Practice Address - Fax:231-276-6903
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1581901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice