Provider Demographics
NPI:1851483192
Name:HENRY, CHARLES HAMMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HAMMAN
Last Name:HENRY
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 1:40 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3421
Mailing Address - Country:US
Mailing Address - Phone:603-352-1973
Mailing Address - Fax:603-352-6270
Practice Address - Street 1:40 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3421
Practice Address - Country:US
Practice Address - Phone:603-352-1973
Practice Address - Fax:603-352-6270
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH24491223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30005801Medicaid
NH30005801Medicaid
NHU01922Medicare UPIN