Individual provider Active NPI

Robert Braga Henson

  • General Practice Dentistry
  • Columbia, SC
National Provider Identifier
1215344577
Registry record updated Jul 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8433 Issued in SC
Practice address
10266 Two Notch Rd
Columbia, SC 29229-4400
Phone
(803) 563-6942
NPI assigned
Jul 18, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8433 SC Primary

Addresses

Primary practice location

10266 Two Notch Rd
Columbia, SC 29229-4400

Mailing address

751 Mallet Road Apt. 8207
Columbia, SC 29223
Phone (701) 552-2974

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

LicenseStateTypeSpecialty
8433SCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Robert B. Henson DDS PLLC CurrentSince Jun 30, 2024 Accepting new patients

Locations

11441 Osage St NW
Ste 2
Coon Rapids, MN 55433
Phone (763) 757-6600

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405641600000",
    "number": "1215344577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 MALLET ROAD APT. 8207",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29223",
            "telephone_number": "701-552-2974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10266 TWO NOTCH RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292294400",
            "telephone_number": "803-563-6942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENSON",
        "first_name": "ROBERT",
        "middle_name": "BRAGA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-18",
        "last_updated": "2014-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "8433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2014; 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.