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General NPI Number Information
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NPI Number | 1225127947
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Entity Type | Organization
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Legal Business Name | FLOREK HENDERSON DENTAL LLC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 1380 S COMMERCIAL ST
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City | NEENAH
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State | WI
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Zip | 54956-4636
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Country | US
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Telephone | 920-725-5357
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Fax | 920-969-9813
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Provider Business Mailing Address
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Address Line | 1380 S COMMERCIAL ST
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City | NEENAH
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State | WI
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Zip | 54956-4636
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Country | US
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Telephone | 920-725-5357
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Fax | 920-969-9813
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON ROBERT HENDERSON
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Credential | D.D.S.
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Telephone | 920-725-5357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5223-015
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License Number State | WI
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