Individual
HENRY L DEGENOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
28321 S TAMIAMI TRL, BONITA SPRINGS, FL 34134-3226
(239) 344-2322
(239) 390-0523
Mailing address
PO BOX 1357, FORT MYERS, FL 33902-1357
(239) 278-3600
(239) 278-3857
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30-01-1576
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075698900
—
FL
Enumeration date
12/19/2005
Last updated
06/17/2011
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