Active NPI
Laurel Kelsey Alyssa Henderson, DDS
- Dentist
- Stanford, CA
National Provider Identifier
1205309648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 104477
- Practice address
- 300 Pasteur Dr
Stanford, CA 94305-2200 - Phone
- (650) 723-4000
- NPI assigned
- Jan 8, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 104477 | CA | Primary |
| Orofacial Pain Dentistry | 1223X2210X | 104477 | CA | |
| Oral Medicine Dentistry | 125Q00000X | 104477 | CA |
Addresses
Primary practice location
300 Pasteur Dr
Stanford, CA 94305-2200
Mailing address
300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000
Other practice location 1
725 Albany Street, 6th Floor
Suite 6A
Boston, MA 02118
Phone (617) 358-6775
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Oral Surgery
- Education
- University of South Carolina School of Medicine, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
100 E Newton St
G407
Boston, MA 02118-3552
Phone (617) 638-4350
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trustees of Boston University | Current | Accepting new patients | |
| Boston Medical Center Corporation | Current | Accepting new patients |
Locations
725 Albany St
Fl 6
Boston, MA 02118
Phone (617) 414-2243
100 East Newton St
#G407
Boston, MA 02118
Phone (617) 638-4350
110 Francis St
Ste 3A
Boston, MA 02215
Phone (617) 632-9780
Interoperability endpoints
- lhenderson268480@direct.bmc.masshiway.net
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Oral and Maxillofacial Surgery (Dentist)
- Boston, MA
- NPI 1154331916
-
- General Acute Care Hospital
- Boston, MA
- NPI 1346218294
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Boston, MA
- NPI 1164177028
-
- Community Health Clinic/Center
- South Boston, MA
- NPI 1225228679
Hospital
-
- General Acute Care Hospital
- Boston, MA
- NPI 1346218294
-
- Community Health Clinic/Center
- Roslindale, MA
- NPI 1386718823
Hospital
-
- Community Health Clinic/Center
- Dorchester, MA
- NPI 1780874677
Hospital
-
- Community Health Clinic/Center
- East Boston, MA
- NPI 1861683518
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788307200000",
"number": "1205309648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 PASTEUR DR",
"city": "STANFORD",
"state": "CA",
"postal_code": "943052200",
"telephone_number": "650-723-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 PASTEUR DR",
"city": "STANFORD",
"state": "CA",
"postal_code": "943052200",
"telephone_number": "650-723-4000"
}
],
"practiceLocations": [
{
"address_1": "725 Albany Street, 6th Floor",
"address_2": "Suite 6A",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "02118",
"country_code": "US",
"telephone_number": "617-358-6775",
"fax_number": "617-358-6781",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HENDERSON",
"first_name": "LAUREL",
"middle_name": "KELSEY ALYSSA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-08",
"last_updated": "2026-09-02",
"certification_date": "2026-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "104477",
"primary": true
},
{
"code": "1223X2210X",
"taxonomy_group": "",
"desc": "Dentist, Orofacial Pain",
"state": "CA",
"license": "104477",
"primary": false
},
{
"code": "125Q00000X",
"taxonomy_group": "",
"desc": "Dentist, Oral Medicine",
"state": "CA",
"license": "104477",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stanford, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.