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General NPI Number Information
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NPI Number | 1831586684
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Entity Type | Organization
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Legal Business Name | HENDERSON & HENDERSON -LOS ALTOS DENTAL CORPORATION
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 350 2ND ST SUITE 3
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City | LOS ALTOS
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State | CA
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Zip | 94022-3695
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Country | US
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Telephone | 650-948-0200
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Fax | 650-949-0951
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Provider Business Mailing Address
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Address Line | 350 2ND ST SUITE 3
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City | LOS ALTOS
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State | CA
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Zip | 94022-3695
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Country | US
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Telephone | 650-948-0200
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Fax | 650-949-0951
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. DENISE M HENDERSON
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Credential | D.D.S.
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Telephone | 650-948-0200
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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 | 50267
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 51552
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License Number State | CA
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