Provider Demographics
NPI:1093760274
Name:HENSON, DONALD D (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:D
Last Name:HENSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 HIGHLAND PLACE WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4036
Mailing Address - Country:US
Mailing Address - Phone:865-588-0578
Mailing Address - Fax:865-588-7699
Practice Address - Street 1:6230 HIGHLAND PLACE WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4036
Practice Address - Country:US
Practice Address - Phone:865-588-0578
Practice Address - Fax:865-588-7699
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000043991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0129416OtherBLUE CROSS PROVIDER NUMBE