Healthcare Provider Details

I. General information

NPI: 1871687004
Provider Name (Legal Business Name): LYMAN B HENDERSON JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/07/2025
Certification Date: 10/06/2023
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:
Title or Position:
Credential:
Phone: