Randal James Henneberg, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60102400 Issued in WA

Practice address

12701 E Sprague Ave
Spokane Valley, WA 99216-0727

Phone

(509) 924-0055

NPI assigned

Aug 11, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Henneberg & Hsu III, PLLC

  • General Practice Dentistry
  • Spokane Valley, WA
  • NPI 1669776811
  NPD (past) Authorized official
• RJ Henneberg, PLLC

  • General Practice Dentistry
  • Moses Lake, WA
  • NPI 1700490356
  NPD
• Robert a Ebert, DDS

  • Dentist
  • Coeur D Alene, ID
  • NPI 1467684175
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1083846927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12701 E SPRAGUE AVE",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992160727",
            "telephone_number": "509-924-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12701 E SPRAGUE AVE",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992160727",
            "telephone_number": "509-924-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNEBERG",
        "first_name": "RANDAL",
        "middle_name": "JAMES",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-11",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-4246",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60102400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Hendrick
• Parker Hendricks
• Heidi Hendrickson
• Henneberg & Hsu III, PLLC
• Jeffrey J Henneberg, DDS
• Jade Chloe Hennings, M.D.
• Gabriella Hennington
• Daena Hensley, OTR
• Julia Purko Hentges
• Caitlin Faith Herbst

• General Practice Dentistry in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.