Individual
DR. MARLON D. HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9096 WALKER RD, SHREVEPORT, LA 71118-2440
(318) 687-6453
Mailing address
PO BOX 3387, SHREVEPORT, LA 71133-3387
(318) 617-3727
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5407
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1854077
—
LA
Enumeration date
11/01/2006
Last updated
03/19/2012
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