Provider Demographics
NPI:1033737507
Name:HENDERSON, SYDNEY BROOKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:BROOKE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:SYDNEY
Other - Middle Name:BROOKE
Other - Last Name:HESLEP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5903
Mailing Address - Country:US
Mailing Address - Phone:479-254-6899
Mailing Address - Fax:479-254-6899
Practice Address - Street 1:312 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5903
Practice Address - Country:US
Practice Address - Phone:479-254-6899
Practice Address - Fax:479-254-6899
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR44371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice