Provider Demographics
NPI:1942388822
Name:HENNY, PAUL ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDREW
Last Name:HENNY
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 1:1213 CORPORATE CIR SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1491
Mailing Address - Country:US
Mailing Address - Phone:540-774-1577
Mailing Address - Fax:
Practice Address - Street 1:1213 CORPORATE CIR SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1491
Practice Address - Country:US
Practice Address - Phone:540-774-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010073591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice