Gary Marshall Henley, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

014443 Issued in MO

Practice address

6156 Evergreen Blvd
Berkeley, MO 63134-2108

Phone

(314) 522-1032

Fax

(314) 524-1292

NPI assigned

Oct 13, 2005

Last updated

Apr 5, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 MO

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": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270425600000",
    "number": "1861481707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6156 EVERGREEN BLVD",
            "city": "BERKELEY",
            "state": "MO",
            "postal_code": "631342108",
            "telephone_number": "314-522-1032",
            "fax_number": "314-524-1292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6156 EVERGREEN BLVD",
            "city": "BERKELEY",
            "state": "MO",
            "postal_code": "631342108",
            "telephone_number": "314-522-1032",
            "fax_number": "314-524-1292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENLEY",
        "first_name": "GARY",
        "middle_name": "MARSHALL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2010-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "014443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402309207",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Berkeley, MO
• Providers in Berkeley, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2010; 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.