Provider Demographics
NPI:1861844912
Name:HENRY, MARILYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W GOODALE ST APT 561
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1910
Mailing Address - Country:US
Mailing Address - Phone:859-801-3961
Mailing Address - Fax:
Practice Address - Street 1:4TH FLOOR, POSTLE HALL
Practice Address - Street 2:305 W. 12TH AVE.
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-292-3596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001798-15122300000X
KY98211223G0001X
OH30.026745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice