Provider Demographics
NPI:1134395304
Name:HENRY G. CHENEY JR., D.M.D., P.C.
Entity type:Organization
Organization Name:HENRY G. CHENEY JR., D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-388-3505
Mailing Address - Street 1:41 SPARHAWK ST
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3317
Mailing Address - Country:US
Mailing Address - Phone:978-388-3505
Mailing Address - Fax:
Practice Address - Street 1:41 SPARHAWK ST
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-3317
Practice Address - Country:US
Practice Address - Phone:978-388-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX09590OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS