Provider Demographics
NPI:1619163367
Name:CARL E HENLEYDDS & ASSOCIATES PC
Entity Type:Organization
Organization Name:CARL E HENLEYDDS & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FAGD
Authorized Official - Phone:630-357-9393
Mailing Address - Street 1:931 W 75TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1294
Mailing Address - Country:US
Mailing Address - Phone:630-357-9393
Mailing Address - Fax:630-357-9380
Practice Address - Street 1:931 W 75TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1294
Practice Address - Country:US
Practice Address - Phone:630-357-9393
Practice Address - Fax:630-357-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190188061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7575410001Medicare NSC