Mark William Henderson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5078 Issued in AL

Practice address

23D Medical Group 3278 Mitchell Blvd
Moody Afb, GA 31699-1500

Phone

(229) 257-1459

NPI assigned

Oct 5, 2005

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": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524614400000",
    "number": "1992792840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23D MEDICAL GROUP 3278 MITCHELL BLVD",
            "city": "MOODY AFB",
            "state": "GA",
            "postal_code": "316991500",
            "telephone_number": "229-257-1459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23D MEDICAL GROUP 3278 MITCHELL BLVD",
            "city": "MOODY AFB",
            "state": "GA",
            "postal_code": "316991500",
            "telephone_number": "229-257-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MARK",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2018-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "5078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin Thomas Geer, IDMT
• Cleona Marie Griffin
• Matthew Thomas Hamrick, PA-C
• Brenna Katherine Harrington, DMD
• Hedera Counseling Center
• Connor Andrew Henson, IDMT
• Kimberly Hines, LCSW
• Shondra Shantel Holmes, LCSW
• Bailey Holt, IDMT
• Daniel Houser, MD

• General Practice Dentistry in Moody Afb, GA
• Providers in Moody Afb, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2018; 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.