Individual
RANDAL JAMES HENNEBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
12701 E SPRAGUE AVE, SPOKANE VALLEY, WA 99216-0727
(509) 924-0055
Mailing address
12701 E SPRAGUE AVE, SPOKANE VALLEY, WA 99216-0727
(509) 924-0055
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D-4246
ID
1223G0001X
General Practice Dentistry
Primary
DE60102400
WA
Other
Enumeration date
08/11/2009
Last updated
08/17/2021
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