Provider Demographics
NPI:1780752675
Name:ST. GERMAIN, HENRY ALBERT JR (DMD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ALBERT
Last Name:ST. GERMAIN
Suffix:JR
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 1:5521 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9232
Mailing Address - Country:US
Mailing Address - Phone:402-472-1278
Mailing Address - Fax:402-472-5290
Practice Address - Street 1:40TH AND HOLDREGE STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0750
Practice Address - Country:US
Practice Address - Phone:402-472-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5886OtherBC/BS