Provider Demographics
NPI:1073775771
Name:ROBERT L. HENDERSON, D.M.D PSC
Entity Type:Organization
Organization Name:ROBERT L. HENDERSON, D.M.D PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-743-7480
Mailing Address - Street 1:903 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-1023
Mailing Address - Country:US
Mailing Address - Phone:606-743-7480
Mailing Address - Fax:606-743-7481
Practice Address - Street 1:903 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-1023
Practice Address - Country:US
Practice Address - Phone:606-743-7480
Practice Address - Fax:606-743-7481
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT L. HENDERSON, D.M.D, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental