Provider Demographics
NPI:1780808774
Name:HENRY, C. ROBERT JR (DDS,MS)
Entity type:Individual
Prefix:
First Name:C.
Middle Name:ROBERT
Last Name:HENRY
Suffix:JR
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 W LOOP 250 N
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3191
Mailing Address - Country:US
Mailing Address - Phone:432-682-1222
Mailing Address - Fax:432-683-7412
Practice Address - Street 1:4810 W LOOP 250 N
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3191
Practice Address - Country:US
Practice Address - Phone:432-682-1222
Practice Address - Fax:432-683-7412
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics