Provider Demographics
NPI:1609938406
Name:FORD, HENRY C (DMD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:C
Last Name:FORD
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 1:181 ACADEMY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3178
Mailing Address - Country:US
Mailing Address - Phone:207-764-6337
Mailing Address - Fax:207-764-1446
Practice Address - Street 1:181 ACADEMY ST STE 1
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3178
Practice Address - Country:US
Practice Address - Phone:207-764-6337
Practice Address - Fax:207-764-1446
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME34261223S0112X
NH32241223S0112X
MEDEN3426204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132730000Medicaid
ME9760835OtherCIGNA
ME037356OtherBLUE CROSS
ME2209645OtherAETNA
ME2209645OtherAETNA
MEMM5154Medicare ID - Type Unspecified