MEDICARE: CONNOR HENDERSON DMD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1003707399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNOR HENDERSON DMD PLLC

Provider Business Mailing Address
First Line	:	3187 MOSSFIELD AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4580
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3047 E WARM SPRINGS RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3761
Country	:	US
Telephone Number	:	801-874-5917
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. CONNOR HENDERSON
Credential	:	DMD
Telephone Number	:	801-874-5917

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/14/2025

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