Provider Demographics
NPI:1215085717
Name:HENRY, SAMUEL SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SCOTT
Last Name:HENRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:SCOTT
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, PC
Mailing Address - Street 1:279 SOUTH HWY 46
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155
Mailing Address - Country:US
Mailing Address - Phone:830-372-2852
Mailing Address - Fax:830-372-3133
Practice Address - Street 1:279 SOUTH HWY 46
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155
Practice Address - Country:US
Practice Address - Phone:830-372-2852
Practice Address - Fax:830-372-3133
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice