Provider Demographics
NPI:1356183503
Name:HENRY, AYDEN (DDS)
Entity type:Individual
Prefix:DR
First Name:AYDEN
Middle Name:
Last Name:HENRY
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 1:318 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-7884
Mailing Address - Country:US
Mailing Address - Phone:417-204-3301
Mailing Address - Fax:
Practice Address - Street 1:413 N MCCROSKEY ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9330
Practice Address - Country:US
Practice Address - Phone:417-725-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024019618122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist