MEDICARE: DR. OBERT P 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
1	122300000X	Dentist	11751	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1546445	OTHER	MD	UNITED CORCORDIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	S444	OTHER	MD	THE DENTAL NETWORK

General Provider Information

NPI Number	:	1801878038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OBERT P HENRY DDS

Provider Business Mailing Address
First Line	:	831 UNIVERSITY BLVD E
Second Line	:	SUITE 36B
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2916
Country	:	US
Telephone Number	:	301-431-1660
Fax Number	:	301-431-1004

Provider Business Practice Location Address
First Line	:	831 UNIVERSITY BLVD E
Second Line	:	SUITE 36B
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2916
Country	:	US
Telephone Number	:	301-431-1660
Fax Number	:	301-431-1004

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	08/14/2007

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