Provider Demographics
NPI:1073278628
Name:R. GARY HENSLEY, D.M.D., P.A.
Entity Type:Organization
Organization Name:R. GARY HENSLEY, D.M.D., P.A.
Other - Org Name:MAGNOLIA DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-284-2108
Mailing Address - Street 1:912 DONTIA DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3643
Mailing Address - Country:US
Mailing Address - Phone:980-284-2108
Mailing Address - Fax:980-284-2083
Practice Address - Street 1:912 DONTIA DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3643
Practice Address - Country:US
Practice Address - Phone:980-284-2108
Practice Address - Fax:980-284-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty