MEDICARE: ROBERT W DMD HUSKEY

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	332BC3200X	Customized Equipment (DME)	3215	AL
2	122300000X	Dentist	3215	AL

General Provider Information

NPI Number	:	1003205089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT W DMD HUSKEY

Provider Business Mailing Address
First Line	:	1610 2ND AVE
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-5618
Country	:	US
Telephone Number	:	334-745-6295
Fax Number	:	334-749-3002

Provider Business Practice Location Address
First Line	:	1610 2ND AVE
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-5618
Country	:	US
Telephone Number	:	334-745-6295
Fax Number	:	334-749-3002

Authorized Official
Title or Position	:	OWER
Name	:	DR. ROBERT W HUSKEY
Credential	:	D.M.D.
Telephone Number	:	334-745-6295

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	06/25/2015

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