Provider Demographics
NPI:1548374762
Name:CARBONNEAU, HENRI PAUL JR (DMD)
Entity type:Individual
Prefix:DR
First Name:HENRI
Middle Name:PAUL
Last Name:CARBONNEAU
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:HENRI
Other - Middle Name:PAUL
Other - Last Name:CARBONNEAU
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:159 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:CT
Mailing Address - Zip Code:06232-1535
Mailing Address - Country:US
Mailing Address - Phone:860-742-7144
Mailing Address - Fax:
Practice Address - Street 1:159 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:CT
Practice Address - Zip Code:06232-1535
Practice Address - Country:US
Practice Address - Phone:860-742-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT40521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics