Individual
DR. THEODORE B HENNIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
4350 FASHION SQUARE BOULEVARD, SAGINAW, MI 48603-1249
(989) 799-7128
(989) 799-3895
Mailing address
4350 FASHION SQUARE BOULEVARD, SAGINAW, MI 48603-1249
(989) 799-7128
(989) 799-3895
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901014716
MI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
2901014716
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OG361000
BLUE CARE NETWORK
MI
Enumeration date
11/27/2006
Last updated
09/11/2025
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