Provider Demographics
NPI:1205404399
Name:AUBREY J HENSHAW III DDS PC
Entity Type:Organization
Organization Name:AUBREY J HENSHAW III DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENSHAW
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-775-4431
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-0708
Mailing Address - Country:US
Mailing Address - Phone:918-775-4431
Mailing Address - Fax:918-775-4432
Practice Address - Street 1:611 W RUTH AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-6866
Practice Address - Country:US
Practice Address - Phone:918-775-4431
Practice Address - Fax:918-775-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental