MEDICARE: NAIDA HENRIQUEZ DDS

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	122300000X	Dentist	038567-1	NY

General Provider Information

NPI Number	:	1770645640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAIDA HENRIQUEZ DDS

Provider Business Mailing Address
First Line	:	239 N BROADWAY
Second Line	:	SUITE#2
City	:	SLEEPY HOLLOW
State	:	NY
Zip	:	10591-2674
Country	:	US
Telephone Number	:	914-524-0440
Fax Number	:	914-769-2458

Provider Business Practice Location Address
First Line	:	239 N BROADWAY
Second Line	:	SUITE #2
City	:	SLEEPY HOLLOW
State	:	NY
Zip	:	10591-2674
Country	:	US
Telephone Number	:	914-524-0440
Fax Number	:	914-769-2458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	01/31/2011

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