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Contact Information

SHAUN HENDERSON, DMD
3 ROAD 6523
KIRTLAND, NM87417-9452
 Phone: 505-598-6800
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for SHAUN HENDERSON · (Male)

NPI Number 1982133849
Status Active
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 06/05/2017
Last updated 07/21/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • NM License # DD4700
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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