Provider Demographics
NPI:1437132164
Name:HENSON, JOSHUA FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:FREDERICK
Last Name:HENSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:FREDERICK
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:NMCP
Mailing Address - Street 2:620 JOHN PAUL JONES CIR
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-8718
Practice Address - Fax:757-953-8572
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OTHMedicare UPIN