Active NPI
Mark Alan Henry, DDS MS
- Endodontics
- Peru, IL
National Provider Identifier
1184889644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 021001743
- Practice address
- 2050 Marquette Rd
Suite 300
Peru, IL 61354 - Phone
- (815) 223-9931
- Fax
- (815) 223-9689
- NPI assigned
- Jul 24, 2008
- Last updated
- Jul 24, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 021001743 | IL | Primary |
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 1
- Mark A Henry
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: 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
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021001743 | IL | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216857600000",
"number": "1184889644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050 MARQUETTE RD",
"address_2": "SUITE 300",
"city": "PERU",
"state": "IL",
"postal_code": "61354",
"telephone_number": "815-223-9931",
"fax_number": "815-223-9689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050 MARQUETTE RD",
"address_2": "SUITE 300",
"city": "PERU",
"state": "IL",
"postal_code": "61354",
"telephone_number": "815-223-9931",
"fax_number": "815-223-9689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRY",
"first_name": "MARK",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "DDS MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-24",
"last_updated": "2008-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "IL",
"license": "021001743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARK",
"last_name": "HENRY",
"middle_name": "A",
"credential": "DDS MS PC",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Peru, IL
- Timothy Paul Haas, D.D.S.
- Hanger Prosthetics & Orthotics, Inc (Hanger Clinic)
- Krystal C Hanson
- Diane Marie Harrod, PHARMACIST
- Health and Safety International, Inc
- Heritage Manor - Peru, LLC (Heritage Health - Peru)
- Heritage Manor - Peru, LLC (Heritage Health)
- Kendra Renee Herman, PT, ATC
- Debra Herz, FNP-BC
- Andrea Elizabeth Heslet
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.