Provider Demographics
NPI:1780603688
Name:HENRY, BYRON T (DDS)
Entity type:Individual
Prefix:DR
First Name:BYRON
Middle Name:T
Last Name:HENRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 N HIGH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4038
Mailing Address - Country:US
Mailing Address - Phone:614-885-3339
Mailing Address - Fax:614-885-1011
Practice Address - Street 1:6641 N HIGH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4038
Practice Address - Country:US
Practice Address - Phone:614-885-3339
Practice Address - Fax:614-885-1011
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH209981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU89501Medicare UPIN
OH4072261Medicare PIN