Healthcare Provider Details

I. General information

NPI: 1326697327
Provider Name (Legal Business Name): CHRISTOPHER E HENDERSON, DDS, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11843 SEBASTIAN WAY
RANCHO CUCAMONGA CA
91730-0710
US

IV. Provider business mailing address

11843 SEBASTIAN WAY
RANCHO CUCAMONGA CA
91730-0710
US

V. Phone/Fax

Practice location:
  • Phone: 909-481-6867
  • Fax:
Mailing address:
  • Phone: 909-481-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER ERIC HENDERSON
Title or Position: OWNER
Credential: DDS
Phone: 909-481-6867