Provider Demographics
NPI:1003283458
Name:HENNING, ANDREW D (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:HENNING
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29001 CEDAR RD STE 453
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6501
Mailing Address - Country:US
Mailing Address - Phone:440-446-1300
Mailing Address - Fax:
Practice Address - Street 1:1011 W LITTLE CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2025
Practice Address - Country:US
Practice Address - Phone:757-440-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0277891223E0200X
VA04014186601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics