Provider Demographics
NPI:1912544735
Name:CASEY, HENRI JADE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HENRI
Middle Name:JADE
Last Name:CASEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:HENRI
Other - Middle Name:JADE
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:84 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-9579
Mailing Address - Country:US
Mailing Address - Phone:870-718-6110
Mailing Address - Fax:
Practice Address - Street 1:100 S BLISS AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2512
Practice Address - Country:US
Practice Address - Phone:870-718-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-01
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice