Healthcare Provider Details

I. General information

NPI: 1023767217
Provider Name (Legal Business Name): MACKENZIE SUE HENRY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GEISINGER MEDICAL CENTER 100 N ACADEMY AVE MC 13-36
DANVILLE PA
17822-0001
US

IV. Provider business mailing address

GEISINGER MEDICAL CENTER 100 N ACADEMY AVE MC 13-36
DANVILLE PA
17822-0001
US

V. Phone/Fax

Practice location:
  • Phone: 570-214-2128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: