Provider Demographics
NPI:1629394630
Name:FAILING, HENRY ROBERTSON III (HENRY FAILING)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ROBERTSON
Last Name:FAILING
Suffix:III
Gender:M
Credentials:HENRY FAILING
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 2172
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-2172
Mailing Address - Country:US
Mailing Address - Phone:541-549-6766
Mailing Address - Fax:
Practice Address - Street 1:340 SE HIGH ST.
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:OR
Practice Address - Zip Code:97750-0217
Practice Address - Country:US
Practice Address - Phone:541-462-3310
Practice Address - Fax:541-763-2850
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD45801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice