Provider Demographics
NPI:1265840342
Name:HENSLEY, TRISTAN D (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:D
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-5119
Mailing Address - Country:US
Mailing Address - Phone:727-849-4246
Mailing Address - Fax:727-849-0701
Practice Address - Street 1:1928 HIGHLAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7323
Practice Address - Country:US
Practice Address - Phone:813-949-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist