Individual
DR. SHAUN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3 ROAD 6523, KIRTLAND, NM 87417-9452
(505) 598-6800
Mailing address
3 ROAD 6523, KIRTLAND, NM 87417-9452
(505) 598-6800
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD4700
NM
Other
Enumeration date
06/05/2017
Last updated
07/21/2022
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