Provider Demographics
NPI:1427058296
Name:DENNEHY, ANNE HEUBACH (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:HEUBACH
Last Name:DENNEHY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7169
Mailing Address - Country:US
Mailing Address - Phone:541-245-6648
Mailing Address - Fax:541-245-6647
Practice Address - Street 1:801 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7169
Practice Address - Country:US
Practice Address - Phone:541-245-6648
Practice Address - Fax:541-245-6647
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2012-03-19
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
ORP69821223P0221X
OH300179811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR064746OtherOMAP