Individual
DR. REGINA L. HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
10400 MALLARD CREEK RD, SUITE 103, CHARLOTTE, NC 28262-9772
(704) 503-0202
(704) 503-0609
Mailing address
10400 MALLARD CREEK RD, SUITE 103, CHARLOTTE, NC 28262-9772
(704) 503-0202
(704) 503-0609
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6487
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9011X
—
NC
Enumeration date
07/28/2006
Last updated
07/08/2007
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