Provider Demographics
NPI:1538565601
Name:HENDERSON, HELEN (RDA)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 S MAIN ST APT 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-4517
Mailing Address - Country:US
Mailing Address - Phone:702-809-5710
Mailing Address - Fax:
Practice Address - Street 1:5125 S MAIN ST APT 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-4517
Practice Address - Country:US
Practice Address - Phone:702-809-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63046126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant