Michael Henderson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D13957 Issued in MN

Practice address

3200 Lexington Ave N Ste B
Shoreview, MN 55126-8118

Phone

(651) 255-8888

NPI assigned

Mar 5, 2017

Last updated

Feb 16, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Dental Care Inc

  • General Practice Dentistry
  • Buffalo, MN
  • NPI 1275280810
  NPD (past)

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

{
    "created_epoch": "1488672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1821538265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 LEXINGTON AVE N STE B",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551268118",
            "telephone_number": "651-255-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 LEXINGTON AVE N STE B",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551268118",
            "telephone_number": "651-255-8888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "606 24th Ave S",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554541455",
            "country_code": "US",
            "telephone_number": "612-659-8689",
            "fax_number": "612-659-8690",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1670 Beam Ave Ste 204",
            "address_purpose": "LOCATION",
            "city": "Maplewood",
            "state": "MN",
            "postal_code": "551091227",
            "country_code": "US",
            "telephone_number": "651-925-8400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-05",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13957",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13957",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jayne M Hart, DPT
• Samira Omar Hassan
• Mary Ruth Hayes I, C.N.M.
• Melanie Haynes, LGSW
• Michael Douglas Head, D.C.
• Toni Henning, MS, CCC-SLP
• Amy Beth Hertle, L.I.C.S.W., L.P.
• Levi John Hibma
• Annie Elizabeth Hinnenkamp
• Nathan Philip Hinrichs, MD

• Dentist in Shoreview, MN
• Providers in Shoreview, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; 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.