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General NPI Number Information
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NPI Number | 1629300272
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Entity Type | Individual
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Provider Name | HENRY LUCIEN HARBERT ENDODONTIST, DMD
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Gender | Male
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Dates
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Enumeration Date | 02/08/2010
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 691 MURPHY RD. STE 204
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City | MEDFORD
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State | OR
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Zip | 97504
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Country | US
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Telephone | 541-245-0984
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Fax | 541-245-9018
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Provider Business Mailing Address
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Address Line | 691 MURPHY RD. STE 204
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City | MEDFORD
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State | OR
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Zip | 97504
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Country | US
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Telephone | 541-245-0984
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Fax | 541-245-9018
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D4429
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License Number State | OR
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