Provider Demographics
NPI:1164722039
Name:HENRY, JAMES E (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:HENRY
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 PTARMIGAN LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1424
Mailing Address - Country:US
Mailing Address - Phone:719-528-5806
Mailing Address - Fax:719-594-4210
Practice Address - Street 1:2310 PTARMIGAN LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1424
Practice Address - Country:US
Practice Address - Phone:719-528-5806
Practice Address - Fax:719-594-4210
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD1-009521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice