Healthcare Provider Details

I. General information

NPI: 1609796994
Provider Name (Legal Business Name): FOUR LIONS DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68100 RAMON RD STE A4
CATHEDRAL CITY CA
92234-3389
US

IV. Provider business mailing address

74237 ROYCE DR
PALM DESERT CA
92211-0874
US

V. Phone/Fax

Practice location:
  • Phone: 703-507-1820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHAD HENDERSON
Title or Position: OWNER/ORTHODONTIST
Credential: DDS
Phone: 703-507-1820