Provider Demographics
NPI:1144361262
Name:HENRY, KATHRYN G (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:G
Last Name:HENRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6644 S JAMESTOWN PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-2615
Mailing Address - Country:US
Mailing Address - Phone:918-493-9480
Mailing Address - Fax:
Practice Address - Street 1:5319 S LEWIS AVE STE 222
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6543
Practice Address - Country:US
Practice Address - Phone:918-742-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice