MEDICARE: DR. JAMES E. HENRY DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	HD1-00952	CO

General Provider Information

NPI Number	:	1164722039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES E. HENRY DDS PC

Provider Business Mailing Address
First Line	:	2310 PTARMIGAN LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1424
Country	:	US
Telephone Number	:	719-528-5806
Fax Number	:	719-594-4210

Provider Business Practice Location Address
First Line	:	2310 PTARMIGAN LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1424
Country	:	US
Telephone Number	:	719-528-5806
Fax Number	:	719-594-4210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	10/26/2010

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