Provider Demographics
NPI:1518651462
Name:SCHELLHORN, HENRY JAMES
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JAMES
Last Name:SCHELLHORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 N FRANKLIN ST UNIT 419
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-8472
Mailing Address - Country:US
Mailing Address - Phone:608-306-1531
Mailing Address - Fax:
Practice Address - Street 1:2316 W MADISON ST # 2228
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2228
Practice Address - Country:US
Practice Address - Phone:312-491-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034272122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist