Individual
WILLIAM DAVID HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, PT
Contact information
Practice address
5935 HIGHWAY 18 W, JACKSON, MS 39209-9625
(601) 922-7028
(601) 922-9005
Mailing address
5935 HIGHWAY 18 W, JACKSON, MS 39209-9625
(601) 922-7028
(601) 922-9005
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3496-09
MS
225100000X
Physical Therapist
PT 2975
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050976
BCBS
MS
05
—
00121341
—
MS
01
—
7416031
AETNA #
MS
Enumeration date
11/03/2006
Last updated
08/16/2011
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