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General NPI Number Information
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NPI Number | 1114192911
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Entity Type | Organization
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Legal Business Name | RICHARD G. HENRY
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 112 VAL VERDE
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City | ALTUS
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State | OK
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Zip | 73521
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Country | US
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Telephone | 580-482-0441
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Fax | 580-482-0443
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Provider Business Mailing Address
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Address Line | 112 VAL VERDE
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City | ALTUS
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State | OK
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Zip | 73521
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Country | US
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Telephone | 580-482-0441
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Fax | 580-482-0443
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Authorized Official
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Title or Position | BUSINESS ASSISTANT
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Name | DEBORAH P SPLAWN
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Credential |
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Telephone | 580-482-0441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4246
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6043
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 4975
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4975
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License Number State | OK
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