Provider Demographics
NPI:1073697009
Name:R. GARY HENSLEY D.M.D. PA I
Entity Type:Organization
Organization Name:R. GARY HENSLEY D.M.D. PA I
Other - Org Name:DR. GARY HENSELY & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:HOLLEY
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-438-2880
Mailing Address - Street 1:500 BURKEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4410
Mailing Address - Country:US
Mailing Address - Phone:828-438-2880
Mailing Address - Fax:828-430-7668
Practice Address - Street 1:500 BURKEMONT AVE
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4410
Practice Address - Country:US
Practice Address - Phone:828-438-2880
Practice Address - Fax:828-430-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013CHMedicaid
NC8990125Medicaid