Active NPI
Latisha Deidra Henderson, DMD, MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Marlton, NJ
National Provider Identifier
1578079828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 22DI02697000
- Practice address
- 1000 Lincoln Dr E
Marlton, NJ 08053-1566 - Phone
- (877) 422-6257
- NPI assigned
- Dec 22, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 22DI02697000 | NJ | Primary |
Addresses
Primary practice location
1000 Lincoln Dr E
Marlton, NJ 08053-1566
Mailing address
128 Alter St
Philadelphia, PA 19147-5406
Phone (856) 534-4326
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02697000 | NJ | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| My Smile But Better | Orthodontics and Dentofacial Orthopedics | Current | Accepting new patients |
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.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Mount Laurel, NJ
- NPI 1457121618
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704412800000",
"number": "1578079828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "128 ALTER ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191475406",
"telephone_number": "856-534-4326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 LINCOLN DR E",
"city": "MARLTON",
"state": "NJ",
"postal_code": "080531566",
"telephone_number": "877-422-6257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "LATISHA",
"middle_name": "DEIDRA",
"name_prefix": "Dr.",
"credential": "DMD, MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-22",
"last_updated": "2024-01-05",
"certification_date": "2024-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NJ",
"license": "22DI02697000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marlton, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.