Individual
DR. THEODORE MARK HENNESSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
181 S 333RD ST, SUITE C-100, FEDERAL WAY, WA 98003-7363
(253) 661-6381
Mailing address
19715 SCRIBER LAKE RD, SUITE C, LYNNWOOD, WA 98036-6165
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00010589
WA
Other
Enumeration date
11/11/2006
Last updated
06/21/2012
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