| Organization Name: | ROBERT L. HENDERSON, D.M.D PSC |
| NPI Number: | 1073775771 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT L HENDERSON (OFFICE MANAGER) |
| Mailing Address: | 903 Main St West Liberty |
| State: | KY US |
| Postal Code: | 414721023 |
| Phone Number: | 6067437480 |
| Fax Number: | 6067437481 |
| NPI Enumeration Date: | 06/25/2008 |
| NPI Last Update Date: | 08/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |