Basic Information
| Provider Information | |||||||||
| NPI: | 1992900740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDERSON | ||||||||
| FirstName: | CHASITY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5225 KATY FWY | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770072264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326730999 | ||||||||
| FaxNumber: | 2816572406 | ||||||||
| Practice Location | |||||||||
| Address1: | 8550 S BRAESWOOD BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770711109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137780999 | ||||||||
| FaxNumber: | 7134906755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 20543 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.