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General NPI Number Information
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NPI Number | 1780355644
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Entity Type | Individual
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Provider Name | HIRVING HENRIQUEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 53 FAIRVIEW ST
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6630
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Country | US
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Telephone | 802-490-2923
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Fax |
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Provider Business Mailing Address
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Address Line | 82 CRYSTAL BROOK DRIVE
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City | SPRINGFIELD
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State | MA
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Zip | 01118-3755
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Country | US
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Telephone | 917-214-4343
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2023016832
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 04950
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 13751
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 016.0134056
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License Number State | VT
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