Provider Demographics
NPI:1922355403
Name:HUANG, HENRY (DDS)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:HUANG
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 1:241 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-3007
Mailing Address - Country:US
Mailing Address - Phone:518-776-4939
Mailing Address - Fax:518-930-4666
Practice Address - Street 1:241 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-3007
Practice Address - Country:US
Practice Address - Phone:518-776-4939
Practice Address - Fax:518-930-4666
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0562031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03546494Medicaid