MEDICARE: DR. ROBERT JOSEPH HENRY DDS, MS

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	1223P0221X	Pediatric Dentistry	7734	CO

General Provider Information

NPI Number	:	1720086788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JOSEPH HENRY DDS, MS

Provider Business Mailing Address
First Line	:	2624 GRAND AVE
Second Line	:	SUITE 200
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4176
Country	:	US
Telephone Number	:	970-928-9500
Fax Number	:	970-928-7467

Provider Business Practice Location Address
First Line	:	2624 GRAND AVE
Second Line	:	SUITE 200
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4176
Country	:	US
Telephone Number	:	970-928-9500
Fax Number	:	970-928-7467

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/08/2007

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