Provider Demographics
NPI:1063516102
Name:HENRY, GEORGE JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JAMES
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 1:43205 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1957
Mailing Address - Country:US
Mailing Address - Phone:586-247-9700
Mailing Address - Fax:586-247-5782
Practice Address - Street 1:43205 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1957
Practice Address - Country:US
Practice Address - Phone:586-247-9700
Practice Address - Fax:586-247-5782
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI014420OtherDENTIST