MEDICARE: ROBERT BRIAN HEINRICH 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	7144	WA

General Provider Information

NPI Number	:	1124111679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BRIAN HEINRICH DDS

Provider Business Mailing Address
First Line	:	10121 N NEVADA ST STE 302
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-3120
Country	:	US
Telephone Number	:	506-467-1117
Fax Number	:	506-467-1116

Provider Business Practice Location Address
First Line	:	10121 N NEVADA ST STE 302
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-3120
Country	:	US
Telephone Number	:	506-467-1117
Fax Number	:	506-467-1116

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/03/2012

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