Healthcare Provider Details

I. General information

NPI: 1386738516
Provider Name (Legal Business Name): HENDERSON & HENDERSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W RIDGEWAY ST
WARRENTON NC
27589-1716
US

IV. Provider business mailing address

516 W RIDGEWAY ST
WARRENTON NC
27589-1716
US

V. Phone/Fax

Practice location:
  • Phone: 252-257-3054
  • Fax: 252-257-4755
Mailing address:
  • Phone: 252-257-3054
  • Fax: 252-257-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3093
License Number StateNC

VIII. Authorized Official

Name: DR. KARA M HENDERSON
Title or Position: DENTIST
Credential: DDS
Phone: 252-257-3054