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General NPI Number Information
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NPI Number | 1497961338
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Entity Type | Individual
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Provider Name | KELLI HENDERSON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1425 WAKARUSA DR SUITE D
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City | LAWRENCE
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State | KS
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Zip | 66049-3832
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Country | US
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Telephone | 405-706-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 WAKARUSA DR SUITE D
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City | LAWRENCE
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State | KS
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Zip | 66049-3832
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Country | US
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Telephone |
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 5743
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 60453
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License Number State | KS
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