Individual provider Active NPI

James Timothy Henley, DDS

  • General Practice Dentistry
  • Rohnert Park, CA
National Provider Identifier
1528114196
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
26179 Issued in CA
Practice address
5200 Snyder LN
Rohnert Park, CA 94928-2929
Phone
(707) 584-8057
Fax
(707) 584-8057
NPI assigned
Jan 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 26179 CA Primary

Addresses

Primary practice location

5200 Snyder LN
Rohnert Park, CA 94928-2929

Mailing address

5200 Snyder LN
Rohnert Park, CA 94928-2929
Phone (707) 584-8057

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20151203002461 CA Order and Referring Only - DentistPractitioner - Dentist 8325348998

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26179CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528114196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 SNYDER LN",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282929",
            "telephone_number": "707-584-8057",
            "fax_number": "707-584-8057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 SNYDER LN",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282929",
            "telephone_number": "707-584-8057",
            "fax_number": "707-584-8057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENLEY",
        "first_name": "JAMES",
        "middle_name": "TIMOTHY",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "26179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rohnert Park, CA

Sources for this page

Verify at the official NPI Registry.