Provider Demographics
NPI:1346433455
Name:FERNANDA L HENSLEY,DMD.PC
Entity Type:Organization
Organization Name:FERNANDA L HENSLEY,DMD.PC
Other - Org Name:FERNANDA L HENSLEY ,DMD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:F
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:615-452-0236
Mailing Address - Street 1:158 ALBERT GALLATIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2076
Mailing Address - Country:US
Mailing Address - Phone:615-452-0236
Mailing Address - Fax:615-230-7768
Practice Address - Street 1:158 ALBERT GALLATIN AVE
Practice Address - Street 2:A
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2076
Practice Address - Country:US
Practice Address - Phone:615-452-0236
Practice Address - Fax:615-230-7768
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS005029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty