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General NPI Number Information
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NPI Number | 1962210286
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Entity Type | Organization
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Legal Business Name | HENDERSON DENTAL PLLC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 425 E TABERNACLE ST
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City | SAINT GEORGE
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State | UT
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Zip | 84770-2941
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Country | US
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Telephone | 435-688-1400
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Fax | 435-608-4479
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Provider Business Mailing Address
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Address Line | 425 E TABERNACLE ST
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City | SAINT GEORGE
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State | UT
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Zip | 84770-2941
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Country | US
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Telephone | 435-688-1400
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Fax | 435-608-4479
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Authorized Official
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Title or Position | OWNER
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Name | BRANDON HENDERSON
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Credential | DMD
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Telephone | 435-688-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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