Provider Demographics
NPI:1407917800
Name:MARCANTONI, HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:MARCANTONI
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 1:10801 N MO PAC EXPY
Mailing Address - Street 2:BLDG. 2 STE.130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5459
Mailing Address - Country:US
Mailing Address - Phone:512-372-6230
Mailing Address - Fax:512-372-6233
Practice Address - Street 1:10801 N MO PAC EXPY
Practice Address - Street 2:BLDG. 2 STE.130
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5459
Practice Address - Country:US
Practice Address - Phone:512-372-6230
Practice Address - Fax:512-372-6233
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202376140OtherTAX ID
TX175391501Medicaid
TX175392302Medicaid
TX18386OtherLICENSE
TXB18386OtherCHIP