Individual
MATTHEW HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1439 STILLWATER AVE STE 7, CHEYENNE, WY 82009-7367
(307) 778-7800
Mailing address
39375 RIDGE PARK DRIVE, SEVERANCE, CO 80610
(970) 674-0101
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1290
AK
1223P0221X
Pediatric Dentistry
Primary
1245
WY
Other
Enumeration date
03/05/2009
Last updated
07/14/2010
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