Provider Demographics
NPI:1104533660
Name:ANDREW W HENRITZE DDS PLLC
Entity type:Organization
Organization Name:ANDREW W HENRITZE DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVEABLE ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:HAWKINS
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:544-077-6655
Mailing Address - Street 1:PO BOX 63381
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3611 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3611
Practice Address - Country:US
Practice Address - Phone:540-991-5151
Practice Address - Fax:540-202-9339
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDREW W HENRITZE DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental