Provider Demographics
NPI:1295343804
Name:HENRY, GABRIELLE GENEVIEVE (DDS)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:GENEVIEVE
Last Name:HENRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 WINDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-9453
Mailing Address - Country:US
Mailing Address - Phone:319-560-9801
Mailing Address - Fax:
Practice Address - Street 1:401 HAGANMAN LN
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:IA
Practice Address - Zip Code:52333-9760
Practice Address - Country:US
Practice Address - Phone:319-624-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice