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General NPI Number Information
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NPI Number | 1326697327
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER E HENDERSON, DDS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 11843 SEBASTIAN WAY
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0710
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Country | US
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Telephone | 909-481-6867
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Fax |
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Provider Business Mailing Address
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Address Line | 11843 SEBASTIAN WAY
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0710
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Country | US
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Telephone | 909-481-6867
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER ERIC HENDERSON
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Credential | DDS
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Telephone | 909-481-6867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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