Healthcare Provider Details

I. General information

NPI: 1922355403
Provider Name (Legal Business Name): HENRY HUANG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 ROUTE 9W
GLENMONT NY
12077-3007
US

IV. Provider business mailing address

241 ROUTE 9W
GLENMONT NY
12077-3007
US

V. Phone/Fax

Practice location:
  • Phone: 518-776-4939
  • Fax: 518-930-4666
Mailing address:
  • Phone: 518-776-4939
  • Fax: 518-930-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number056203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: