Provider Demographics
NPI:1073205977
Name:HENDERSON, JAMES JOSEPH III (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:HENDERSON
Suffix:III
Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:1414 CHRISTIAN STREET
Mailing Address - Street 2:APT 3 REAR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146
Mailing Address - Country:US
Mailing Address - Phone:215-622-1386
Mailing Address - Fax:
Practice Address - Street 1:3503 YORK RD STE 5
Practice Address - Street 2:
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925-1175
Practice Address - Country:US
Practice Address - Phone:215-622-1386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0431321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics