Provider Demographics
NPI:1275695876
Name:MASEK, HENRY MARCUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:MARCUS
Last Name:MASEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:HENRY
Other - Middle Name:MARCUS
Other - Last Name:MASEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1650 OAKBROOK DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093
Mailing Address - Country:US
Mailing Address - Phone:770-446-8000
Mailing Address - Fax:770-446-8000
Practice Address - Street 1:6568 TARA ROAD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-961-2000
Practice Address - Fax:770-961-9692
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA089971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice