Robert E. Henderson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10905 Issued in TX

Practice address

824 E Redd Rd
Ste. 1-B
El Paso, TX 79912-7262

Phone

(915) 833-0303

NPI assigned

Aug 8, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 24, 2016 through Feb 24, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284595200000",
    "number": "1275543092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 E REDD RD",
            "address_2": "STE. 1-B",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799127262",
            "telephone_number": "915-833-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 E REDD RD",
            "address_2": "STE. 1-B",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799127262",
            "telephone_number": "915-833-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "ROBERT",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2010-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "10905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DENT08841",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron Joseph Henckel, DC
• Tarah L Henderson-Toderic, DO
• Gary Lee Henderson, RPH
• Lorena Carrillo Henderson, RN, FNP-C
• Rachel Henderson
• Christopher S. Hendricks, RN
• Erin Marie Hendricks, MS CCC-SLP
• Gordon C. Hendricks, O.D., M.S.
• Lisa Michelle Hendrix, NP
• Bryce Thomas Hendryx, M.D.

• General Practice Dentistry in El Paso, TX
• Providers in El Paso, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.