Marlon D. Henderson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5407 Issued in LA

Practice address

9096 Walker Rd
Shreveport, LA 71118-2440

Phone

(318) 687-6453

NPI assigned

Nov 1, 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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332115200000",
    "number": "1285711234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3387",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711333387",
            "telephone_number": "318-617-3727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9096 WALKER RD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711182440",
            "telephone_number": "318-687-6453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MARLON",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1854077",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jermissia Latrice Henderson, ACNPC-AG
• Jessica Henderson
• Kourteni Henderson
• Letetia Henderson, LCSW
• Lisa Lynn Henderson
• Marquita Henderson
• Ralph Jonathan Henderson, M.D.
• Rickshard Henderson
• Sharice Henderson, FNP-BC
• Shaterica Janae Henderson

• General Practice Dentistry in Shreveport, LA
• Providers in Shreveport, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2012; 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.