Provider Demographics
NPI:1275743890
Name:HENRY, GUY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GUY
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6105 W JERSEY AVE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5202
Mailing Address - Country:US
Mailing Address - Phone:609-568-6270
Mailing Address - Fax:609-568-6259
Practice Address - Street 1:6105 W JERSEY AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5202
Practice Address - Country:US
Practice Address - Phone:609-568-6270
Practice Address - Fax:609-568-6259
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016394001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics