Provider Demographics
NPI:1619968450
Name:HENDERSON, FELIPA MESSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:FELIPA
Middle Name:MESSON
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W 177TH ST
Mailing Address - Street 2:2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7100
Mailing Address - Country:US
Mailing Address - Phone:212-568-1338
Mailing Address - Fax:212-568-1339
Practice Address - Street 1:611 W 177TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7100
Practice Address - Country:US
Practice Address - Phone:212-568-1338
Practice Address - Fax:212-568-1339
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0484061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01995871Medicaid