Provider Demographics
NPI:1083627640
Name:HENLEY, GEORGE GREGORY (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:GREGORY
Last Name:HENLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SNYDER LN
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2929
Mailing Address - Country:US
Mailing Address - Phone:707-584-9589
Mailing Address - Fax:707-584-8057
Practice Address - Street 1:5200 SNYDER LN
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2929
Practice Address - Country:US
Practice Address - Phone:707-584-9589
Practice Address - Fax:707-584-8057
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice