| Henderson Family Dentistry | |
|
1910 State Hwy 43 East Henderson TX 75652 | |
| (903) 657-3139 | |
| (903) 655-0699 |
| Full Name | Henderson Family Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1910 State Hwy 43 East, Henderson, Texas |
| Authorized Official Name and Position | Brian C Jackson (OWNER/PARTNER) |
| Authorized Official Contact | 9036573139 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Henderson Family Dentistry 1910 State Hwy 43 East Henderson TX 75652 Ph: (903) 657-3139 | Henderson Family Dentistry 1910 State Hwy 43 East Henderson TX 75652 Ph: (903) 657-3139 |
| NPI Number | 1780992586 |
|---|---|
| Provider Enumeration Date | 09/15/2010 |
| Last Update Date | 06/04/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780992586 | NPI | - | NPPES |
| 0901829-02 | Medicaid | TX | |
| 194671701 | Medicaid | TX | |
| 0901829-07 | Medicaid | TX | |
| 1946717-07 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 19316 (Texas) | Primary |