Provider Demographics
NPI:1780355644
Name:HENRIQUEZ, HIRVING (DDS)
Entity type:Individual
Prefix:
First Name:HIRVING
Middle Name:
Last Name:HENRIQUEZ
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 1:82 CRYSTAL BROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-3755
Mailing Address - Country:US
Mailing Address - Phone:917-214-4343
Mailing Address - Fax:
Practice Address - Street 1:53 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6630
Practice Address - Country:US
Practice Address - Phone:802-490-2923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230168321223G0001X
NH049501223G0001X
CT13751390200000X
VT016.01340561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program