Individual
DR. MARK WILLIAM HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
23D MEDICAL GROUP 3278 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-1459
Mailing address
23D MEDICAL GROUP 3278 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-1459
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5078
AL
Other
Enumeration date
10/05/2005
Last updated
04/25/2018
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