Mark Alan Henry, DDS MS
Individual provider Active NPI Endodontics · Peru, IL
NPI 1184889644 · NPPES record last updated Jul 24, 2008
Key facts
- NPI
- 1184889644
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- 021001743 (IL)
- Practice address
- 2050 Marquette Rd
Suite 300
Peru, IL 61354 - Phone
- (815) 223-9931
- Fax
- (815) 223-9689
- NPI assigned
- Jul 24, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 8, 2016 through Jul 8, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021001743 | IL | MD | Endodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 021001743 | IL | Yes |
Addresses
Primary practice location
2050 Marquette Rd
Suite 300
Peru, IL 61354
Mailing address
2050 Marquette Rd
Suite 300
Peru, IL 61354
Phone (815) 223-9931
Other names
- Mark A Henry
Other providers in Peru, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.