Individual
LAUREN ALYSSIA HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5180 PARK AVE STE 210, MEMPHIS, TN 38119-3530
(901) 763-0850
Mailing address
212 WALTER PAYTON LN, RIDGELAND, MS 39157-5011
(601) 331-4467
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10849
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2018
Last updated
07/15/2019
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