Provider Demographics
NPI:1356860324
Name:BRETT R. HENSON, DDS, PA
Entity Type:Organization
Organization Name:BRETT R. HENSON, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-637-3636
Mailing Address - Street 1:640 STATESVILLE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2215
Mailing Address - Country:US
Mailing Address - Phone:704-637-3636
Mailing Address - Fax:704-637-3184
Practice Address - Street 1:640 STATESVILLE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2215
Practice Address - Country:US
Practice Address - Phone:704-637-3636
Practice Address - Fax:704-637-3184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10610261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental