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General NPI Number Information
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NPI Number | 1154890267
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Entity Type | Organization
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Legal Business Name | MATTHEW J HENRY DDS PL
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 11/30/2018
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Provider Practice Location Address
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Address Line | 14054 BEACH BLVD STE 10
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City | JACKSONVILLE
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State | FL
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Zip | 32250-1596
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Country | US
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Telephone | 904-821-8330
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Fax |
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Provider Business Mailing Address
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Address Line | 13624 MARSH HARBOR DR N
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City | JACKSONVILLE
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State | FL
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Zip | 32225-2641
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Country | US
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Telephone | 305-336-0554
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW JACKSON HENRY
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Credential | DDS
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Telephone | 305-336-0554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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