Individual
STEPHEN P. HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
15525 POMERADO RD STE C4, POWAY, CA 92064-2426
(858) 487-0173
(858) 487-0513
Mailing address
15525 POMERADO RD STE C4, POWAY, CA 92064-2426
(858) 487-0173
(858) 487-0513
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
29291
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29291
STATE LISCENSE NUMBER
CA
01
—
45946
UNITED CONCORDIA ID NUMBE
CA
Enumeration date
05/16/2007
Last updated
07/08/2007
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