Provider Demographics
NPI:1750505251
Name:HENDERSON, JULIANA CRAN (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:CRAN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 S 28TH AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2524
Mailing Address - Country:US
Mailing Address - Phone:601-450-2141
Mailing Address - Fax:601-450-2143
Practice Address - Street 1:704 S 28TH AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2524
Practice Address - Country:US
Practice Address - Phone:601-450-2141
Practice Address - Fax:601-450-2143
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2476-891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics