Braxton Henderson, DMD

Primary specialty

Dental AnesthesiologyTaxonomy code 1223D0004X

License

0401416381 Issued in VA

Practice address

510 Nicholas Rd Ste F
Greensboro, NC 27409-3404

Phone

(252) 213-8484

NPI assigned

Apr 14, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Braxton M Henderson DMD PA

  dba Southern Office-Based Anesthesia

  • Dental Anesthesiology
  • Greensboro, NC
  • NPI 1154902021
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1043664188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 MAIN ST",
            "city": "OXFORD",
            "state": "NC",
            "postal_code": "275653323",
            "telephone_number": "252-213-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 NICHOLAS RD STE F",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274093404",
            "telephone_number": "252-213-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "BRAXTON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-14",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS040743",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "NC",
            "license": "10942",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "VA",
            "license": "0401416381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyarah Hemmons
• Hemophilia First LLC
• Megan Hendel
• Britni Amber Henderly, PA-C
• Adrienne Atwood Henderson, MPT
• David J Henderson, M.D.
• Diamond Henderson, LCMHCA
• Fodina Chanelle Henderson, M.S
• Gregory Henderson
• Jonathan Austin Henderson, MD

• Dental Anesthesiology in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Dental Anesthesiology in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.