MEDICARE: MR. HENRY LEE CONAWAY JR. 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	122300000X	Dentist	9044	TX

General Provider Information

NPI Number	:	1316151434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HENRY LEE CONAWAY JR. DDS

Provider Business Mailing Address
First Line	:	901 NORMAL PARK
Second Line	:	SUITE 202
City	:	HUNTSVILLE
State	:	TX
Zip	:	77320-3770
Country	:	US
Telephone Number	:	936-295-0932
Fax Number	:	936-295-4876

Provider Business Practice Location Address
First Line	:	901 NORMAL PARK
Second Line	:	SUITE 202
City	:	HUNTSVILLE
State	:	TX
Zip	:	77320-3770
Country	:	US
Telephone Number	:	936-295-0932
Fax Number	:	936-295-4876

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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