Provider Demographics
NPI:1760539670
Name:GEORGE O. HENDERSON DDS LTD DBA THE DENTISTS' OFFICE
Entity Type:Organization
Organization Name:GEORGE O. HENDERSON DDS LTD DBA THE DENTISTS' OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:O
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-423-7400
Mailing Address - Street 1:1241 S TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-5804
Mailing Address - Country:US
Mailing Address - Phone:775-423-7400
Mailing Address - Fax:775-423-7410
Practice Address - Street 1:1241 S TAYLOR ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-5804
Practice Address - Country:US
Practice Address - Phone:775-423-7400
Practice Address - Fax:775-423-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV24291223G0001X
NV46251223G0001X
NVGR4512TA1223G0001X
NV53471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty