Provider Demographics
NPI:1710043336
Name:DUNCAN, HENRY WALTER (DDS)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:WALTER
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BLOSSOM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1608
Mailing Address - Country:US
Mailing Address - Phone:408-365-7930
Mailing Address - Fax:323-661-8555
Practice Address - Street 1:420 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1608
Practice Address - Country:US
Practice Address - Phone:408-365-7930
Practice Address - Fax:323-661-8555
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice