Theodore M Hennessey DDS PS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00010589 Issued in WA

Legal business name

THEODORE M HENNESSEY DDS PS

Practice address

19715 Scriber Lake Rd Ste C
Lynnwood, WA 98036-6165

Phone

(425) 774-7781

NPI assigned

Jun 17, 2012

Organization subpart

No

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

Authorized official

Name

Theodore M Hennessey, DDS

Title

Owner

Phone

(425) 774-7781

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Louis Eilert, DDS

  • General Practice Dentistry
  • Lynnwood, WA
  • NPI 1053463802
  NPD (past)

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

{
    "created_epoch": "1339891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339891200000",
    "number": "1255694147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19715 SCRIBER LAKE RD STE C",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366165",
            "telephone_number": "425-774-7781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19715 SCRIBER LAKE RD STE C",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366165",
            "telephone_number": "425-774-7781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE M HENNESSEY DDS PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-17",
        "last_updated": "2012-06-17",
        "status": "A",
        "authorized_official_last_name": "HENNESSEY",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-774-7781",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Lynnwood, WA
• Providers in Lynnwood, 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 Jun 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.