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NPI Code Detail

MEDICARE: DR. MICHAEL A HENLEY DDS

MEDICARE: DR. MICHAEL A HENLEY 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
1122300000XDentist4967LA

General Provider Information

NPI Number : 1639260516
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL A HENLEY DDS
Provider Business Mailing Address
First Line : 1625 DAVID RAINES RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-5899
Country : US
Telephone Number : 318-425-2252
Fax Number : 318-227-3357
Provider Business Practice Location Address
First Line : 1625 DAVID RAINES RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-5899
Country : US
Telephone Number : 318-425-2252
Fax Number : 318-227-3357
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MICHAEL A HENLEY DDS” Practice Location

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