Provider Demographics
NPI:1043386477
Name:HENAO, PAULA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:A
Last Name:HENAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7842 N POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3234
Mailing Address - Country:US
Mailing Address - Phone:336-759-0651
Mailing Address - Fax:336-759-7454
Practice Address - Street 1:7842 N POINT BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3234
Practice Address - Country:US
Practice Address - Phone:336-759-0651
Practice Address - Fax:336-759-7454
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3130OtherDELTA
9022JOtherBCBS
NC902RJMedicaid