Provider Demographics
NPI:1225231517
Name:HENDERSON, ROBERT MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 SUNLAKE DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1215
Mailing Address - Country:US
Mailing Address - Phone:806-670-0596
Mailing Address - Fax:
Practice Address - Street 1:6222 W 9TH AVE
Practice Address - Street 2:AMARILLO COLLEGE DENTAL CLINIC
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-0701
Practice Address - Country:US
Practice Address - Phone:806-356-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice