Provider Demographics
NPI:1245347566
Name:HENRY, ROBERT GERTH (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GERTH
Last Name:HENRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:BOB
Other - Middle Name:GERTH
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1933 HART RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2458
Mailing Address - Country:US
Mailing Address - Phone:859-268-8648
Mailing Address - Fax:
Practice Address - Street 1:1933 HART RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2458
Practice Address - Country:US
Practice Address - Phone:859-268-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice