Provider Demographics
NPI:1164894044
Name:HENDERSON, BRETT HOUSTON (DMD, MSD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:HOUSTON
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N PARRISH PL STE 1000
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1003
Mailing Address - Country:US
Mailing Address - Phone:615-824-1700
Mailing Address - Fax:
Practice Address - Street 1:410 N PARRISH PL STE 1000
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1003
Practice Address - Country:US
Practice Address - Phone:615-824-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1316122300000X
TN10288122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist