=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003941204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARL LENEAR HENDERSON DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1217 SOUTH MAIN ST CORRESPONDENCE ONLY POB 1193
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-229-2224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1193
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-229-2224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | SC2533
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------