Provider Demographics
NPI:1093558470
Name:HENRY, JORDAN MARIA (DMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIA
Last Name:HENRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2433
Mailing Address - Country:US
Mailing Address - Phone:305-394-0526
Mailing Address - Fax:
Practice Address - Street 1:210 MAIN ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4008
Practice Address - Country:US
Practice Address - Phone:401-729-5239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN037251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice