Jeffery Y Henderson, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DE60169130 Issued in WA

Practice address

5955 Zeamer Avenue
673Rd MDG
Joint Base Elmendorf-Richardson, AK 99506

Phone

(907) 580-5020

NPI assigned

Sep 9, 2010

Last updated

Jul 21, 2021By the provider in NPPES

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

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": "1283990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1598072654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 ZEAMER AVENUE",
            "address_2": "673RD MDG",
            "city": "JOINT BASE ELMENDORF-RICHARDSON",
            "state": "AK",
            "postal_code": "99506",
            "telephone_number": "907-580-5020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 ZEAMER AVENUE",
            "address_2": "673RD MDG",
            "city": "JOINT BASE ELMENDORF-RICHARDSON",
            "state": "AK",
            "postal_code": "99506",
            "telephone_number": "907-580-5020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JEFFERY",
        "middle_name": "Y",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-09",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60169130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Laurence Able, MD
• John Geselman, MD
• Shannon Elisabeth Hunt, AUD, CCC-A
• Daniel Thomas Knudsen, PA-C
• Courtney Kowalchuk, LCSW
• Jacob Carl Shook, D.O.
• Zachary Trzinski

• Dentist in Joint Base Elmendorf-Richardson, AK
• Providers in Joint Base Elmendorf-Richardson, AK by specialty
• Dentist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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.