Provider Demographics
NPI:1255951174
Name:MCHENRY, AUSTIN RYAN (DMD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:RYAN
Last Name:MCHENRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 E HIGH ST STE 115
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5482
Mailing Address - Country:US
Mailing Address - Phone:480-739-5000
Mailing Address - Fax:
Practice Address - Street 1:5315 E HIGH ST STE 115
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5482
Practice Address - Country:US
Practice Address - Phone:480-739-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD0114921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program