Provider Demographics
NPI:1134491103
Name:DR STEPHEN R. HENRY, DDS PC
Entity type:Organization
Organization Name:DR STEPHEN R. HENRY, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-781-6700
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48094-0660
Mailing Address - Country:US
Mailing Address - Phone:586-781-6700
Mailing Address - Fax:586-781-6819
Practice Address - Street 1:57911 VAN DYKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48094-2763
Practice Address - Country:US
Practice Address - Phone:586-781-6700
Practice Address - Fax:586-781-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty