Provider Demographics
NPI:1144617150
Name:JACOB FRANCIS HENDERSON DDS LLC
Entity Type:Organization
Organization Name:JACOB FRANCIS HENDERSON DDS LLC
Other - Org Name:CENTRAL DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-261-6645
Mailing Address - Street 1:11424 SULLIVAN RD BLDG B
Mailing Address - Street 2:STE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-3615
Mailing Address - Country:US
Mailing Address - Phone:225-261-6645
Mailing Address - Fax:225-262-9061
Practice Address - Street 1:11424 SULLIVAN RD BLDG B
Practice Address - Street 2:STE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3615
Practice Address - Country:US
Practice Address - Phone:225-261-6645
Practice Address - Fax:225-262-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5406261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental