Active NPI
Kenneth E Henley, DDS
- General Practice Dentistry
- Omaha, NE
National Provider Identifier
1023006236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5592
- Practice address
- 2909 S 168TH St
Omaha, NE 68130-2079 - Phone
- (402) 778-0218
- Fax
- (402) 330-3718
- NPI assigned
- Oct 11, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5592 | NE | Primary |
Addresses
Primary practice location
2909 S 168TH St
Omaha, NE 68130-2079
Mailing address
2909 S 168TH St
Omaha, NE 68130-2079
Phone (402) 778-0218
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 20, 2023 through Sep 20, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5592 | NE | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691452800000",
"number": "1023006236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2909 S 168TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681302079",
"telephone_number": "402-778-0218",
"fax_number": "402-330-3718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2909 S 168TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681302079",
"telephone_number": "402-778-0218",
"fax_number": "402-330-3718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENLEY",
"first_name": "KENNETH",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-11",
"last_updated": "2023-08-08",
"certification_date": "2023-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NE",
"license": "5592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.