Healthcare Provider Details

I. General information

NPI: 1427941277
Provider Name (Legal Business Name): STEPHANIE HENDERSON, DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10690 MANGROVE LOOP
PLAIN CITY OH
43064-3541
US

IV. Provider business mailing address

10690 MANGROVE LOOP
PLAIN CITY OH
43064-3541
US

V. Phone/Fax

Practice location:
  • Phone: 614-598-5086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. STEPHANIE HENDERSON
Title or Position: DENTIST
Credential: DDS
Phone: 614-598-5086