Provider Demographics
NPI:1720747272
Name:HENNIGAR & HENNIGAR DMD, PC
Entity type:Organization
Organization Name:HENNIGAR & HENNIGAR DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:HENNIGAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:716-773-1990
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-0574
Mailing Address - Country:US
Mailing Address - Phone:716-773-1990
Mailing Address - Fax:716-773-2280
Practice Address - Street 1:2025 WHITEHAVEN RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1895
Practice Address - Country:US
Practice Address - Phone:716-773-1990
Practice Address - Fax:716-773-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental