Dr. Shaun Henderson, DMD
Dentist in Kirtland, NM. Individual provider (NPI-1).
NPI number1982133849
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1982133849
- Entity type
- Individual (NPI-1)
- Name
- Dr. Shaun Henderson
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 5, 2017
- Last updated
- Jul 21, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | DD4700 | NM | Yes |
Practice location
3 Road 6523Kirtland, NM 87417-9452
Phone 505-598-6800
Mailing address
3 Road 6523Kirtland, NM 87417-9452
Phone 505-598-6800
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Dentist providers in Kirtland, NM
- Taylor Clark, DDSNPI 1336155571
- Cody Burnell Coleman, DDSNPI 1316070303
- Michael DaraisNPI 1730596024
- Chris John Giblette, D.M.DNPI 1871973693
- Bruce Brondon Shaheen, DDSNPI 1851686430
All 6 Dentist providers in Kirtland · All 35 providers in Kirtland
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