Individual
DR. LATISHA DEIDRA HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
1000 LINCOLN DR E, MARLTON, NJ 08053-1566
(877) 422-6257
Mailing address
128 ALTER ST, PHILADELPHIA, PA 19147-5406
(856) 534-4326
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
22DI02697000
NJ
Other
Enumeration date
12/22/2017
Last updated
01/05/2024
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