Individual
DIONNE NICOLE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
605 E 170TH ST, SOUTH HOLLAND, IL 60473-3408
(708) 893-0368
(708) 893-0456
Mailing address
1959 E 166TH PL, SOUTH HOLLAND, IL 60473-2666
(248) 760-1856
(708) 895-2161
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019023986
IL
1223G0001X
General Practice Dentistry
2901017114
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4231409
—
MI
Enumeration date
08/31/2006
Last updated
10/08/2014
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