MEDICARE: CARL E HENLEYDDS & ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019018806	IL

General Provider Information

NPI Number	:	1619163367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL E HENLEYDDS & ASSOCIATES PC

Provider Business Mailing Address
First Line	:	931 W 75TH ST
Second Line	:	SUITE 107
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-1294
Country	:	US
Telephone Number	:	630-357-9393
Fax Number	:	630-357-9380

Provider Business Practice Location Address
First Line	:	931 W 75TH ST
Second Line	:	SUITE 107
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-1294
Country	:	US
Telephone Number	:	630-357-9393
Fax Number	:	630-357-9380

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARL E HENLEY
Credential	:	DDS, FAGD
Telephone Number	:	630-357-9393

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	03/14/2017

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