Provider Demographics
NPI:1154345361
Name:HENRY, PAUL J (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
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 1:693 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3840
Mailing Address - Country:US
Mailing Address - Phone:570-714-4343
Mailing Address - Fax:570-718-6668
Practice Address - Street 1:693 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3840
Practice Address - Country:US
Practice Address - Phone:570-714-4343
Practice Address - Fax:570-718-6668
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0161811223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics