Provider Demographics
NPI:1225194384
Name:HENSLEE, EDWIN EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:EUGENE
Last Name:HENSLEE
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 1:8811 E RENO AVE
Mailing Address - Street 2:SUITE103
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7731
Mailing Address - Country:US
Mailing Address - Phone:405-733-1701
Mailing Address - Fax:405-733-5432
Practice Address - Street 1:8811 E RENO AVE
Practice Address - Street 2:SUITE103
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7731
Practice Address - Country:US
Practice Address - Phone:405-733-1701
Practice Address - Fax:405-733-5432
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery