Stephen M Henry, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN14864 Issued in FL

Practice address

4615 Philips Hwy Ste 3
Jacksonville, FL 32207-9506

Phone

(904) 508-0710

Fax

(855) 299-7010

NPI assigned

Dec 21, 2006

Last updated

Oct 10, 2019By the provider in NPPES

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1851455117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4440 FRUITVILLE RD",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342321926",
            "telephone_number": "941-366-0134",
            "fax_number": "941-404-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4615 PHILIPS HWY STE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322079506",
            "telephone_number": "904-508-0710",
            "fax_number": "855-299-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "STEPHEN",
        "middle_name": "M",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-21",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN14864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024032400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Jackson Henry, DDS
• Melisa Henry, MSN, APRN, PMHNP-BC
• Michael Lewis Henry, NP
• Miguel Henry
• Rebecca Basha Henry, LCSW
• Takim Henry, DPT
• Tanisha M Henry, PA
• Tynesha Henry
• Kelly-Jo Simpson Henson, PA-C
• Kenneth Hentschel, DO, PHD

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, 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 Oct 10, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.