Provider Demographics
NPI:1437109782
Name:HENRY, NELSON DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:DAVID
Last Name:HENRY
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 1:309 SAINT THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1278
Mailing Address - Country:US
Mailing Address - Phone:207-728-7557
Mailing Address - Fax:207-728-7558
Practice Address - Street 1:309 SAINT THOMAS ST
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1278
Practice Address - Country:US
Practice Address - Phone:207-728-7557
Practice Address - Fax:207-728-7558
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME23341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice