Provider Demographics
NPI:1922395961
Name:HENDERSON, LINDSEY MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:MARIE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LINDSEY
Other - Middle Name:GASKIN
Other - Last Name:SHOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PSC 561 BOX 1864
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96310-0019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MCAS IWAKUNI
Practice Address - Street 2:11TH DENTAL CO DET IWAKUNI, BUILDING 110, DENTAL CLINIC
Practice Address - City:IWAKUNI-SHI
Practice Address - State:YAMAGUCHI
Practice Address - Zip Code:7400025
Practice Address - Country:JP
Practice Address - Phone:315-255-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3593-11122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist