Provider Demographics
NPI:1588842223
Name:R. GARY HENSLEY, DMD, PA I
Entity Type:Organization
Organization Name:R. GARY HENSLEY, DMD, PA I
Other - Org Name:DR. GARY HENSLEY & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:HOLLEY
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-438-2880
Mailing Address - Street 1:1103 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-3528
Mailing Address - Country:US
Mailing Address - Phone:828-659-7323
Mailing Address - Fax:828-655-1905
Practice Address - Street 1:1103 E COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-3528
Practice Address - Country:US
Practice Address - Phone:828-659-7323
Practice Address - Fax:828-655-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013T0Medicaid