Provider Demographics
NPI:1699318410
Name:ANDREW HENRITZE DDS PLLC
Entity type:Organization
Organization Name:ANDREW HENRITZE DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-588-7312
Mailing Address - Street 1:1103 BROOKDALE ST STE E
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-4531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1103 BROOKDALE ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4528
Practice Address - Country:US
Practice Address - Phone:276-632-2634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDREW HENRITZE DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty