Provider Demographics
NPI:1578297230
Name:HENDERSON, DANIEL MACON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MACON
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 CLAIRMONT CIR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6630
Mailing Address - Country:US
Mailing Address - Phone:334-488-5519
Mailing Address - Fax:
Practice Address - Street 1:111 N 16TH ST
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5655
Practice Address - Country:US
Practice Address - Phone:334-745-3563
Practice Address - Fax:334-745-3566
Is Sole Proprietor?:No
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD0007081C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice