Provider Demographics
NPI:1063580942
Name:HENRY, RICHARD F (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
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 1:541 WILLIN WAY
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1495
Mailing Address - Country:US
Mailing Address - Phone:859-498-1347
Mailing Address - Fax:859-498-5722
Practice Address - Street 1:541 WILLIN WAY
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1495
Practice Address - Country:US
Practice Address - Phone:859-498-1347
Practice Address - Fax:859-498-5722
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY65091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY600611OtherUNITED CONCORDIA OF PA
KY60065091Medicaid