Provider Demographics
NPI:1295779767
Name:HENDERSON, ROBERT BENSON (MD, DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BENSON
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 N FIELDER RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4697
Mailing Address - Country:US
Mailing Address - Phone:817-861-9911
Mailing Address - Fax:817-277-6679
Practice Address - Street 1:723 N FIELDER RD
Practice Address - Street 2:SUITE E
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4697
Practice Address - Country:US
Practice Address - Phone:817-861-9911
Practice Address - Fax:817-277-6679
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13780Medicare UPIN