Provider Demographics
NPI:1447268685
Name:HENDERSON, WILLIAM D (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8335 WALNUT HILL LN
Mailing Address - Street 2:SUITE 125
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4216
Mailing Address - Country:US
Mailing Address - Phone:214-691-5223
Mailing Address - Fax:214-691-2871
Practice Address - Street 1:8335 WALNUT HILL LN
Practice Address - Street 2:SUITE 125
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4216
Practice Address - Country:US
Practice Address - Phone:214-691-5223
Practice Address - Fax:214-691-2871
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX751827963OtherEIN