Provider Demographics
NPI:1689723124
Name:ERNST, HENRY J
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:J
Last Name:ERNST
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 1:3003 YAMATO RD
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5354
Mailing Address - Country:US
Mailing Address - Phone:561-998-0727
Mailing Address - Fax:
Practice Address - Street 1:3003 YAMATO RD
Practice Address - Street 2:SUITE C-5
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-5354
Practice Address - Country:US
Practice Address - Phone:561-998-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist