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NPI Code Detail

MEDICARE: DR. STEPHEN ROBERT HENRY DDS

MEDICARE: DR. STEPHEN ROBERT HENRY 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
11223G0001XGeneral Practice Dentistry2901016538MI

General Provider Information

NPI Number : 1639293749
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN ROBERT HENRY DDS
Provider Business Mailing Address
First Line : 57911 VAN DYKE RD
Second Line : PO BOX 660
City : WASHINGTON
State : MI
Zip : 48094-2763
Country : US
Telephone Number : 586-781-6700
Fax Number :
Provider Business Practice Location Address
First Line : 57911 VAN DYKE RD
Second Line :
City : WASHINGTON
State : MI
Zip : 48094-2763
Country : US
Telephone Number : 586-781-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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