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Individual
LAUREL KELSEY ALYSSA HENDERSON
Active
Individual
LAUREL KELSEY ALYSSA HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
104477
CA
1223X2210X
Orofacial Pain Dentistry
104477
CA
125Q00000X
Oral Medicine Dentistry
104477
CA
Other
Enumeration date
01/08/2019
Last updated
09/02/2026
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