Provider Demographics
NPI:1770513293
Name:HENDERSON, LORI (DDS)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LORRINE
Other - Middle Name:MARIE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1506 CHAPEL HILL RD, STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5468
Mailing Address - Country:US
Mailing Address - Phone:573-446-6868
Mailing Address - Fax:573-446-5588
Practice Address - Street 1:1506 CHAPEL HILL RD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5504
Practice Address - Country:US
Practice Address - Phone:573-446-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0150061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry