Provider Demographics
NPI:1649783614
Name:DR. LORI HENDERSON
Entity type:Organization
Organization Name:DR. LORI HENDERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-446-6868
Mailing Address - Street 1:1506 CHAPEL HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5504
Mailing Address - Country:US
Mailing Address - Phone:573-446-6868
Mailing Address - Fax:573-446-5588
Practice Address - Street 1:1506 CHAPEL HILL RD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5504
Practice Address - Country:US
Practice Address - Phone:573-446-6868
Practice Address - Fax:573-446-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT150061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty