Provider Demographics
NPI:1548310915
Name:HENRY, ROBERT FRANK (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANK
Last Name:HENRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:FORKS
Mailing Address - State:WA
Mailing Address - Zip Code:98331-1848
Mailing Address - Country:US
Mailing Address - Phone:360-374-9558
Mailing Address - Fax:
Practice Address - Street 1:421 G ST
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9025
Practice Address - Country:US
Practice Address - Phone:360-374-2288
Practice Address - Fax:360-374-2271
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000049341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5524004OtherWA DENTAL SERVICE
WA55240-04Medicaid