Provider Demographics
NPI:1356917389
Name:HENRY, HANNAH ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:ELIZABETH
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 1:112 VAL VERDE ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1190
Mailing Address - Country:US
Mailing Address - Phone:580-482-0441
Mailing Address - Fax:580-482-0441
Practice Address - Street 1:112 VAL VERDE ST STE A
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1190
Practice Address - Country:US
Practice Address - Phone:580-482-0441
Practice Address - Fax:580-482-0443
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice