Provider Demographics
NPI:1194932608
Name:HENDERSON, JAMES STRONG IV (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STRONG
Last Name:HENDERSON
Suffix:IV
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6654 U S HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7936
Mailing Address - Country:US
Mailing Address - Phone:601-264-5756
Mailing Address - Fax:
Practice Address - Street 1:6654 U S HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7936
Practice Address - Country:US
Practice Address - Phone:601-264-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS335305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS900714760OtherPLLC TID
MS3353-05OtherLICENSE #