William Angustus Henderson, DDS
Individual provider Active NPI Dentist · Mathis, TX
NPI 1811087000 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1811087000
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 09323 (TX)
- Practice address
- 1312 E San Patricio
Mathis, TX 78368 - Phone
- (361) 547-3286
- NPI assigned
- Oct 16, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09323 | TX | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 09323 | TX | Yes |
Addresses
Primary practice location
1312 E San Patricio
Mathis, TX 78368
Mailing address
1312 E San Patricio Mathis, Texas 78368
Mathis, TX 78368
Phone (361) 547-3286
Other providers in Mathis, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.