Healthcare Provider Details

I. General information

NPI: 1760485452
Provider Name (Legal Business Name): ROBERT J HENIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 NEW LONDON TPKE STE 211
GLASTONBURY CT
06033-2246
US

IV. Provider business mailing address

131 NEW LONDON TPKE STE 211
GLASTONBURY CT
06033-2246
US

V. Phone/Fax

Practice location:
  • Phone: 860-633-0486
  • Fax: 860-659-2126
Mailing address:
  • Phone: 860-633-0486
  • Fax: 860-659-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4862
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: