Healthcare Provider Details

I. General information

NPI: 1861844912
Provider Name (Legal Business Name): MARILYN HENRY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 AMCENTER DR
MADISON WI
53718-9000
US

IV. Provider business mailing address

5002 AMCENTER DR
MADISON WI
53718-9000
US

V. Phone/Fax

Practice location:
  • Phone: 608-467-3000
  • Fax:
Mailing address:
  • Phone: 859-801-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1001798-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: