Provider Demographics
NPI:1093823585
Name:HENSLEY, FERNANDA LESLIE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:FERNANDA
Middle Name:LESLIE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:FERNANDA
Other - Middle Name:
Other - Last Name:CORDLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:158 A ALBERT GALLATIN AVE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2085
Mailing Address - Country:US
Mailing Address - Phone:615-452-0236
Mailing Address - Fax:615-230-7768
Practice Address - Street 1:158 A ALBERT GALLATIN AVE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2085
Practice Address - Country:US
Practice Address - Phone:615-452-0236
Practice Address - Fax:615-230-7768
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN5029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist