Provider Demographics
NPI:1891951786
Name:HENLEY, CARL EDWARD (DD,S, FAGD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:EDWARD
Last Name:HENLEY
Suffix:
Gender:M
Credentials:DD,S, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 W 75TH ST
Mailing Address - Street 2:STE. 107
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1294
Mailing Address - Country:US
Mailing Address - Phone:630-357-9393
Mailing Address - Fax:630-357-9380
Practice Address - Street 1:931 W 75TH ST
Practice Address - Street 2:STE. 107
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1294
Practice Address - Country:US
Practice Address - Phone:630-357-9393
Practice Address - Fax:630-357-9380
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190188061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice