Provider Demographics
NPI:1265550834
Name:MICHAEL, HENRY RODNEY JR (DMD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:RODNEY
Last Name:MICHAEL
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:H
Other - Middle Name:ROD
Other - Last Name:MICHAEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1690 RIMROCK RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0700
Mailing Address - Country:US
Mailing Address - Phone:406-259-7115
Mailing Address - Fax:
Practice Address - Street 1:1690 RIMROCK RD
Practice Address - Street 2:SUITE D
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0700
Practice Address - Country:US
Practice Address - Phone:406-259-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT11-1501Medicaid