Elbert Maurice Henderson Jr.

Primary specialty

DentistTaxonomy code 122300000X

License

10962 Issued in MI

Practice address

645 Griswold St Ste 224
Detroit, MI 48226-4014

Phone

(313) 263-0230

Fax

(313) 263-0320

NPI assigned

Oct 20, 2006

Last updated

Mar 20, 2018By 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

Enrolled in MI

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

Locations

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.

• Downtown Detroit Dental

  • Dental Clinic/Center
  • Detroit, MI
  • NPI 1134856768
  NPD Authorized official
• Henderson & Associates DDS PC Dba Jolly Smiles Mobile Dental Services

  dba Jolly Smiles Dental

  • Dental Clinic/Center
  • Detroit, MI
  • NPI 1770244972
  Authorized official Same address or phone

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521504000000",
    "number": "1831272368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 GRISWOLD ST STE 224",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482264014",
            "telephone_number": "313-263-0230",
            "fax_number": "313-263-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 GRISWOLD ST STE 224",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482264014",
            "telephone_number": "313-263-0230",
            "fax_number": "313-263-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "ELBERT",
        "middle_name": "MAURICE",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2018-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "10962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Ann Henderson, M.S. CCC-SLP
• Charlesetta Ladina Henderson
• Christopher R Henderson Jr.
• Denico Lynn Henderson, LBSW
• Denise Henderson
• Jennifer Henderson
• Jessica Michelle Henderson
• Joyce Henderson
• Kathy A. Henderson, CAC-1
• Kimberlyn Erica Henderson, RN

• Dentist in Detroit, MI
• Providers in Detroit, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2018; 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.