Provider Demographics
NPI:1679158661
Name:KARA HENDERSON, DDS, PA II
Entity Type:Organization
Organization Name:KARA HENDERSON, DDS, PA II
Other - Org Name:HENDERSON SEDATION AND HOSPITAL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-492-3355
Mailing Address - Street 1:451 RUIN CREEK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5920
Mailing Address - Country:US
Mailing Address - Phone:252-492-3355
Mailing Address - Fax:252-492-9938
Practice Address - Street 1:451 RUIN CREEK RD STE 105
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5920
Practice Address - Country:US
Practice Address - Phone:252-492-3355
Practice Address - Fax:252-492-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1811081037Medicaid