Provider Demographics
NPI:1124096268
Name:HENSCHEL, DOUGLAS JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOHN
Last Name:HENSCHEL
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 1:122 W LANCASTER AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1881
Mailing Address - Country:US
Mailing Address - Phone:610-777-6549
Mailing Address - Fax:610-777-6683
Practice Address - Street 1:122 W LANCASTER AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1881
Practice Address - Country:US
Practice Address - Phone:610-777-6549
Practice Address - Fax:610-777-6683
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019473-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice