=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437587003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARRINGTON & HENRY DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2013
-----------------------------------------------------
Last Update Date | 01/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7410 GREENHAVEN DR SUITE 105
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95831-5158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-393-1363
-----------------------------------------------------
Fax | 916-393-4853
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7410 GREENHAVEN DR SUITE 105
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95831-5158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-393-1363
-----------------------------------------------------
Fax | 916-393-4853
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | MARSHA HENRY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 916-393-1363
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------