Provider Demographics
NPI:1962407866
Name:HENDERSON, ROBIN J (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:J
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2010
Mailing Address - Country:US
Mailing Address - Phone:509-758-6071
Mailing Address - Fax:509-758-6146
Practice Address - Street 1:625 6TH STREET
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2010
Practice Address - Country:US
Practice Address - Phone:509-758-6071
Practice Address - Fax:509-758-6146
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000082501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice