# THEODORE M HENNESSEY DDS PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255694147
- **Authorized official:** THEODORE M HENNESSEY DDS (OWNER)
- **Authorized official phone:** (425) 774-7781

## Contact information

- **Practice address:** 19715 SCRIBER LAKE RD STE C, LYNNWOOD, WA 98036-6165
- **Practice address phone:** (425) 774-7781
- **Mailing address:** 19715 SCRIBER LAKE RD STE C, LYNNWOOD, WA 98036-6165
- **Mailing address phone:** (425) 774-7781

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE00010589 | WA | Yes |

## Other

- **Enumeration date:** 06/17/2012
- **Last updated:** 06/17/2012