MEDICARE: DR. HENRY HONICK III D.D.S.

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	11063	MD

General Provider Information

NPI Number	:	1316160716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY HONICK III D.D.S.

Provider Business Mailing Address
First Line	:	4367 HOLLINS FERRY RD
Second Line	:	SUITE 4C
City	:	BALTIMORE
State	:	MD
Zip	:	21227-3400
Country	:	US
Telephone Number	:	410-536-7279
Fax Number	:	410-536-1007

Provider Business Practice Location Address
First Line	:	4367 HOLLINS FERRY RD
Second Line	:	SUITE 4C
City	:	BALTIMORE
State	:	MD
Zip	:	21227-3400
Country	:	US
Telephone Number	:	410-536-7279
Fax Number	:	410-536-1007

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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