Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 3362 | CT |
NPI | 1053483560 |
---|---|
Provider Name | Dr. Eleanor Covel Henken |
First Address | Hartford, CT 06105 |
Second Address | Hartford, CT 06105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |