MEDICARE: DR. JEFFREY W HENKES DDS

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	3519	NV
2	1223G0001X	General Practice Dentistry	7266	WA

General Provider Information

NPI Number	:	1922257542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY W HENKES DDS

Provider Business Mailing Address
First Line	:	1631 W CRAIG RD
Second Line	:	SUITE 10
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0227
Country	:	US
Telephone Number	:	702-649-6644
Fax Number	:	702-649-9778

Provider Business Practice Location Address
First Line	:	1631 W CRAIG RD
Second Line	:	SUITE 10
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0227
Country	:	US
Telephone Number	:	702-649-6644
Fax Number	:	702-649-9778

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

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	09/18/2008

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