Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS040743 | PA |
Y | 1223D0004X | Dentist Anesthesiologist | 0401416381 | VA |
N | 1223D0004X | Dentist Anesthesiologist | 10942 | NC |
NPI | 1043664188 |
---|---|
Provider Name | Braxton Henderson |
First Address | Oxford, NC 27565-3323 |
Second Address | Greensboro, NC 27409-3404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2016 |
Last Update Date | 05/02/2019 |