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NPI Code Detail

MEDICARE: DR. KENNETH MANGO HENDERSON D.D.S.

MEDICARE: DR. KENNETH MANGO HENDERSON D.D.S.
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
11223G0001XGeneral Practice Dentistry23617TX

General Provider Information

NPI Number : 1295914042
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH MANGO HENDERSON D.D.S.
Provider Business Mailing Address
First Line : 8608 PRESTON RD
Second Line : SUITE 112
City : PLANO
State : TX
Zip : 75024-3316
Country : US
Telephone Number : 888-749-3297
Fax Number :
Provider Business Practice Location Address
First Line : 8608 PRESTON RD
Second Line : SUITE 112
City : PLANO
State : TX
Zip : 75024-3316
Country : US
Telephone Number : 888-749-3297
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2007
Last Update Date : 10/29/2007

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