NPIMap

Organization Active NPI

Henderson Children'S Dentistry, LLC

  • Pediatric Dentistry
  • Henderson, KY
National Provider Identifier
1144916941
Registry record updated Apr 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
HENDERSON CHILDREN'S DENTISTRY, LLC
Practice address
700 Barret Blvd Ste a
Henderson, KY 42420-7526
Phone
(270) 827-5522
Fax
(270) 827-8272
NPI assigned
Apr 14, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2023

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

Authorized official

Name
Dr. Brad Fulkerson, DMD
Title
Member/Owner
Phone
(270) 827-5522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

700 Barret Blvd Ste a
Henderson, KY 42420-7526

Mailing address

PO Box 276
Henderson, KY 42419-0276
Phone (270) 827-5522

Other names 1

  • Henderson Children's Dentistry, LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1681430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681430400000",
    "number": "1144916941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 276",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424190276",
            "telephone_number": "270-827-5522",
            "fax_number": "270-827-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 BARRET BLVD STE A",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424207526",
            "telephone_number": "270-827-5522",
            "fax_number": "270-827-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON CHILDREN'S DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-14",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-14",
        "status": "A",
        "authorized_official_last_name": "FULKERSON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "270-827-5522",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henderson Children's Dentistry, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; 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.