| NPI | 1144916941 |
|---|---|
| Doing Business As | HENDERSON CHILDREN'S DENTISTRY, LLC |
| Entity Type | Organization |
| Authorized Contact | BRAD FULKERSON Member/Owner 270-827-5522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2023-04-14 |