Individual
DR. JACK ALBERT HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
3993 LAKE GROVE AVE, LAKE OSWEGO, OR 97035-4493
(503) 636-0055
Mailing address
18709 MIRKWOOD DR, LAKE OSWEGO, OR 97034-7507
(503) 638-0385
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
OR 5500
OR
Other
Enumeration date
07/27/2006
Last updated
07/08/2007
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