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General NPI Number Information
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NPI Number | 1205309648
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Entity Type | Individual
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Provider Name | LAUREL KELSEY ALYSSA HENDERSON DDS
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Gender | Female
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 725 ALBANY STREET, 6TH FLOOR SUITE 6A
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City | BOSTON
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State | MA
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Zip | 02118
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Country | US
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Telephone | 617-358-6775
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Fax | 617-358-6781
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Provider Business Mailing Address
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Address Line | 725 ALBANY STREET, 6TH FLOOR SUITE 6A
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City | BOSTON
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State | MA
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Zip | 02118
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Country | US
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Telephone | 617-358-6775
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Fax | 617-358-6781
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X2210X
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Taxonomy Name | Orofacial Pain Dentistry
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License Number | 104477
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 125Q00000X
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Taxonomy Name | Oral Medicine Dentistry
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License Number | 104477
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License Number State | CA
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