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General NPI Number Information
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NPI Number | 1255547543
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Entity Type | Organization
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Legal Business Name | HENDERSON AND HENDERSON DDS, INC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 412 E BROAD ST
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City | ELYRIA
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State | OH
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Zip | 44035-6436
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Country | US
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Telephone | 440-323-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 412 E BROAD ST
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City | ELYRIA
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State | OH
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Zip | 44035-6436
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Country | US
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Telephone | 440-323-3339
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GENE HENDERSON
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Credential | D.D.S.
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Telephone | 440-323-3339
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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 | 14676
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License Number State | OH
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