Active NPI
Carl Lenear Henderson, DMD
- Dentist
- Greenwood, SC
National Provider Identifier
1003941204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- SC2533
- Practice address
- 1217 South Main St
Correspondence Only Pob 1193
Greenwood, SC 29646 - Phone
- (864) 229-2224
- NPI assigned
- Feb 21, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | SC2533 | SC | Primary |
Addresses
Primary practice location
1217 South Main St
Correspondence Only Pob 1193
Greenwood, SC 29646
Mailing address
PO Box 1193
Greenwood, SC 29648
Phone (864) 229-2224
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 992533 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SC2533 | SC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003941204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1193",
"city": "GREENWOOD",
"state": "SC",
"postal_code": "29648",
"telephone_number": "864-229-2224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1217 SOUTH MAIN ST",
"address_2": "CORRESPONDENCE ONLY POB 1193",
"city": "GREENWOOD",
"state": "SC",
"postal_code": "29646",
"telephone_number": "864-229-2224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "CARL",
"middle_name": "LENEAR",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "SC2533",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "992533",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.