Dr. Walter E Henderson, D.D.S.
Dentist, General Practice in Fayetteville, AR. Individual provider (NPI-1).
NPI number1013079656
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1013079656
- Entity type
- Individual (NPI-1)
- Name
- Dr. Walter E Henderson
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 13, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 2240 | TN | Yes |
Practice location
179 N Church AveSuite 102
Fayetteville, AR 72701
Phone 479-442-6512 · Fax 479-442-7817
Mailing address
179 N Church AveSuite 102
Fayetteville, AR 72701-5265
Phone 479-442-6512 · Fax 479-442-7817
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