Provider Demographics
NPI:1275653743
Name:HENRIE, PATRICK (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:HENRIE
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:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:TALMAGE
Mailing Address - State:CA
Mailing Address - Zip Code:95481-0416
Mailing Address - Country:US
Mailing Address - Phone:707-468-2176
Mailing Address - Fax:707-462-4151
Practice Address - Street 1:1096 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5737
Practice Address - Country:US
Practice Address - Phone:707-462-5706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice