Jacob Francis Henderson, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

5406 Issued in LA

Practice address

11424 Sullivan Rd BLDG B Suite a
Baton Rouge, LA 70817

Phone

(225) 261-6645

Fax

(225) 262-9061

NPI assigned

Mar 16, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Jacob Francis Henderson DDS LLC

  • Dental Clinic/Center
  • Baton Rouge, LA
  • NPI 1144617150
  NPD (past) Authorized official

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205960424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11424 SULLIVAN RD BLDG B SUITE A",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70817",
            "telephone_number": "225-261-6645",
            "fax_number": "225-262-9061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11424 SULLIVAN RD BLDG B SUITE A",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70817",
            "telephone_number": "225-261-6645",
            "fax_number": "225-262-9061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JACOB",
        "middle_name": "FRANCIS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "5406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Henderson
• Christa Rhodes Henderson, PA-C
• Craig S Henderson, CRNA
• Darryl Henderson
• Denise Marie Henderson
• Jerhonda Deshell Henderson
• Joyce Henderson, CPSS
• Kimberly Henderson
• Marquitha Henderson
• Miranda Allen Henderson, FNP-C

• All providers in Baton Rouge, LA
• Dentist in Louisiana

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.