Individual
DAVID M HENINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3375 MERLIN DR, IDAHO FALLS, ID 83404-7405
(208) 524-1700
(208) 524-1702
Mailing address
3375 MERLIN DR, IDAHO FALLS, ID 83404-7405
(208) 524-1700
(208) 524-1702
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-1921
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22-3889763
—
ID
01
—
D-1921
IDAHO DENTAL LICENSE
ID
Enumeration date
07/27/2006
Last updated
05/04/2009
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