Individual provider Active NPI

Christopher Hans Henry, DMD MS PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • St Augustine, FL
National Provider Identifier
1679684070
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
DN22375 Issued in FL
Practice address
491 Prosperity Lake Dr Ste 301
St Augustine, FL 32092-5045
Phone
(904) 429-0095
Fax
(904) 429-0238
NPI assigned
Aug 31, 2006
Last updated
Mar 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 1099 AK
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X AA1099 AK
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X DN22375 FL Primary

Addresses

Primary practice location

491 Prosperity Lake Dr Ste 301
St Augustine, FL 32092-5045

Mailing address

491 Prosperity Lake Dr Ste 301
St Augustine, FL 32092-5045
Phone (904) 429-0095

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
1099AKMDPediatric Dentist
AA1099AKMDOrthodontics and Dentofacial Orthopedic Dentist
DN22375FLMDOrthodontics and Dentofacial Orthopedic Dentist

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1679684070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "491 PROSPERITY LAKE DR STE 301",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320925045",
            "telephone_number": "904-429-0095",
            "fax_number": "904-429-0238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "491 PROSPERITY LAKE DR STE 301",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320925045",
            "telephone_number": "904-429-0095",
            "fax_number": "904-429-0238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "CHRISTOPHER",
        "middle_name": "HANS",
        "name_prefix": "Dr.",
        "credential": "DMD MS PC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AK",
            "license": "1099",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AK",
            "license": "AA1099",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "DN22375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.