Healthcare Provider Details

I. General information

NPI: 1255951174
Provider Name (Legal Business Name): AUSTIN RYAN MCHENRY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 02/27/2023
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 E HIGH ST STE 115
PHOENIX AZ
85054-5482
US

IV. Provider business mailing address

5315 E HIGH ST STE 115
PHOENIX AZ
85054-5482
US

V. Phone/Fax

Practice location:
  • Phone: 480-739-5000
  • Fax:
Mailing address:
  • Phone: 480-739-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD011492
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: