Henry L Degenova, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30-01-1576 Issued in OH

Practice address

28321 S Tamiami TRL
Bonita Springs, FL 34134-3226

Phone

(239) 344-2322

Fax

(239) 390-0523

NPI assigned

Dec 19, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308268800000",
    "number": "1386620664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1357",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339021357",
            "telephone_number": "239-278-3600",
            "fax_number": "239-278-3857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28321 S TAMIAMI TRL",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341343226",
            "telephone_number": "239-344-2322",
            "fax_number": "239-390-0523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGENOVA",
        "first_name": "HENRY",
        "middle_name": "L",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2011-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-01-1576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075698900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalia Daza
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• Elizabeth Roberts Dear, PHYSICAL THERAPIST
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• Armaghan Aimee Dehbozorgi, DMD
• Erianny Del Rio Acosta, RBT
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• Douglas Demars, LMT

• General Practice Dentistry in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.