Individual
DR. MICHAEL HENNEBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1201 N STONEWALL AVE, OKLAHOMA CITY, OK 73117-1214
(405) 271-4148
Mailing address
1201 N STONEWALL AVE, OKLAHOMA CITY, OK 73117-1214
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6590
OK
Other
Enumeration date
07/01/2015
Last updated
07/01/2015
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