Gregg C Hendrickson

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2681 Issued in NV

Practice address

2790 W Horizon Ridge Pkwy
Suite #100
Henderson, NV 89052-3997

Phone

(702) 735-3284

Fax

(702) 733-5910

NPI assigned

Mar 17, 2008

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

Medicare fee-for-service enrollment

Enrolled in NV

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Comprehensive Dental Care

  • General Practice Dentistry
  • Henderson, NV
  • NPI 1891466108
  NPD (past)

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205712000000",
    "number": "1780855858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 W HORIZON RIDGE PKWY",
            "address_2": "SUITE #100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890523997",
            "telephone_number": "702-735-3284",
            "fax_number": "702-733-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 W HORIZON RIDGE PKWY",
            "address_2": "SUITE #100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890523997",
            "telephone_number": "702-735-3284",
            "fax_number": "702-733-5910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKSON",
        "first_name": "GREGG",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-17",
        "last_updated": "2008-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "2681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Royce Henderson, P.A.C.
• Steven Shawn Henderson
• Tiana N Henderson
• Traci Marie Henderson
• Gomesindo Edward Hendricks, O.D.
• Kilmocku Hendrix
• Sandra Kay Henemyer, FNP-C
• Ketren Henley
• Kathryn Henner
• Megan Hennessy

• General Practice Dentistry in Henderson, NV
• Providers in Henderson, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.