Individual
DR. AMANDA HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
260 E CONGRESS PKWY, SUITE C, CRYSTAL LAKE, IL 60014-6235
(815) 459-4847
Mailing address
260 E CONGRESS PKWY, SUITE C, CRYSTAL LAKE, IL 60014-6235
(815) 459-4847
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019029061
IL
Other
Enumeration date
07/09/2012
Last updated
07/09/2012
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