Individual
JASON DAVID HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8179 CAZENOVIA RD., MANLIUS, NY 13104
(315) 682-2466
(315) 682-3179
Mailing address
8179 CAZENOVIA RD, MANLIUS, NY 13104-9778
(315) 682-2466
(315) 682-3179
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
054488
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316096340
—
NY
Enumeration date
03/27/2008
Last updated
06/13/2012
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