Provider Demographics
NPI:1558095083
Name:HENRY, CORY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:
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 1:1502 W BLUE STARR DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3202
Mailing Address - Country:US
Mailing Address - Phone:918-342-4444
Mailing Address - Fax:918-341-4001
Practice Address - Street 1:1502 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3202
Practice Address - Country:US
Practice Address - Phone:918-342-4444
Practice Address - Fax:918-341-4001
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice