Active NPI
Thomas F. Henke, D.D.S.
- Dentist
- Shawano, WI
National Provider Identifier
1649395682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5001589-015
- Practice address
- 336 S Main St
Shawano, WI 54166-2754 - Phone
- (715) 524-3565
- Fax
- (715) 524-3169
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 5001589-015 | WI | Primary |
Addresses
Primary practice location
336 S Main St
Shawano, WI 54166-2754
Mailing address
336 South Main Street
PO Box 535
Shawano, WI 54166-0535
Phone (715) 524-3565
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5001589-015 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1649395682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "336 SOUTH MAIN STREET",
"address_2": "PO BOX 535",
"city": "SHAWANO",
"state": "WI",
"postal_code": "541660535",
"telephone_number": "715-524-3565",
"fax_number": "715-524-3169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "336 S MAIN ST",
"city": "SHAWANO",
"state": "WI",
"postal_code": "541662754",
"telephone_number": "715-524-3565",
"fax_number": "715-524-3169"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENKE",
"first_name": "THOMAS",
"middle_name": "F.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "5001589-015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shawano, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.