Provider Demographics
NPI:1821380270
Name:HENZEL, CRAIG J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:J
Last Name:HENZEL
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 1:3940 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3043
Mailing Address - Country:US
Mailing Address - Phone:330-493-3940
Mailing Address - Fax:330-493-6061
Practice Address - Street 1:3940 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3043
Practice Address - Country:US
Practice Address - Phone:330-493-3940
Practice Address - Fax:330-493-6061
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice