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NPI Code Detail

MEDICARE: DR. ROBIN J HENDERSON DDS

MEDICARE: DR. ROBIN J HENDERSON DDS
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 DentistryDE00008250WA

General Provider Information

NPI Number : 1962407866
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBIN J HENDERSON DDS
Provider Business Mailing Address
First Line : 625 6TH ST
Second Line :
City : CLARKSTON
State : WA
Zip : 99403-2010
Country : US
Telephone Number : 509-758-6071
Fax Number : 509-758-6146
Provider Business Practice Location Address
First Line : 625 6TH STREET
Second Line :
City : CLARKSTON
State : WA
Zip : 99403-2010
Country : US
Telephone Number : 509-758-6071
Fax Number : 509-758-6146
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/08/2007

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