Provider Demographics
NPI:1205003126
Name:MCHENRY, KORY R (DMD)
Entity Type:Individual
Prefix:DR
First Name:KORY
Middle Name:R
Last Name:MCHENRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7753 N SOUTHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3849
Mailing Address - Country:US
Mailing Address - Phone:954-804-3000
Mailing Address - Fax:
Practice Address - Street 1:7753 N SOUTHWOOD CIR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3849
Practice Address - Country:US
Practice Address - Phone:954-804-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569231223X0400X
HI22921223X0400X
UT59760261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics