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Individual
DR. DALE PRESTON HENKEN
Active
Individual
DR. DALE PRESTON HENKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
G41486
CA
208000000X
Pediatrics Physician
Primary
MD150386
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
NBMC MAIN GROUP NPI
OR
01
—
161133
NBMC MAIN GROUP DMAP
OR
05
—
500630202
—
OR
01
—
93-0635514
NBMC MAIN GROUP TAX ID FOR BILLING
OR
01
—
MD150386
OREON MEDICAL LICENSE
OR
01
—
R0000WFBTV
NBMC MAIN GROUP MEDICARE
OR
Enumeration date
10/07/2008
Last updated
09/26/2011
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