MEDICARE: DR. ROBIN D HENDERSON DMD

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	1223P0300X	Periodontics	0045	OK

General Provider Information

NPI Number	:	1770627044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBIN D HENDERSON DMD

Provider Business Mailing Address
First Line	:	9112 N. MAY AVE,
Second Line	:
City	:	OKLA. CITY
State	:	OK
Zip	:	73120
Country	:	US
Telephone Number	:	405-947-0486
Fax Number	:	405-942-4392

Provider Business Practice Location Address
First Line	:	9112 N. MAY AVE,
Second Line	:
City	:	OKLA. CITY
State	:	OK
Zip	:	73120
Country	:	US
Telephone Number	:	405-947-0486
Fax Number	:	405-942-4392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	09/02/2015

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