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General NPI Number Information
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NPI Number | 1609796994
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Entity Type | Organization
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Legal Business Name | FOUR LIONS DENTAL CORPORATION
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Dates
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Enumeration Date | 07/17/2026
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Last Update Date | 07/17/2026
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Provider Practice Location Address
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Address Line | 68100 RAMON RD STE A4
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City | CATHEDRAL CITY
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State | CA
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Zip | 92234-3389
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Country | US
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Telephone | 703-507-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 74237 ROYCE DR
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City | PALM DESERT
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State | CA
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Zip | 92211-0874
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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 | OWNER/ORTHODONTIST
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Name | CHAD HENDERSON
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Credential | DDS
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Telephone | 703-507-1820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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