Provider Demographics
NPI:1720115819
Name:HENRY, KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:
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 1:260 E CONGRESS PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6235
Mailing Address - Country:US
Mailing Address - Phone:815-459-4847
Mailing Address - Fax:815-459-4857
Practice Address - Street 1:260 E CONGRESS PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6235
Practice Address - Country:US
Practice Address - Phone:815-459-4847
Practice Address - Fax:815-459-4857
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2022-11-29
Deactivation Date:2007-06-13
Deactivation Code:
Reactivation Date:2014-12-04
Provider Licenses
StateLicense IDTaxonomies
IL0190207551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice