Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN1858214 | MA |
NPI | 1013278696 |
---|---|
Provider Name | Andrew Henry |
First Address | Charlotte, NC 28217-0090 |
Second Address | Charlotte, NC 28277-6749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 29/04/2019 |