Organization
JASON D. HENDERSON, DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON D. HENDERSON DDS (OWNER/ DENTIST)
(315) 682-2466
Entity
Organization
Contact information
Practice address
8179 CAZENOVIA RD, MANLIUS, NY 13104-9778
(315) 685-2246
(315) 682-3914
Mailing address
8179 CAZENOVIA RD, MANLIUS, NY 13104-9778
(315) 685-2246
(315) 682-3914
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
054488
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03224320
—
NY
Enumeration date
01/09/2007
Last updated
09/10/2015
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