Provider Demographics
NPI:1740574466
Name:HENLEY-JACKSON, DONNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:HENLEY-JACKSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:605 S CONROE MEDICAL DR
Mailing Address - Street 2:LONE STAR FAMILY HEALTH CENTER
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4722
Mailing Address - Country:US
Mailing Address - Phone:936-523-5292
Mailing Address - Fax:936-521-8450
Practice Address - Street 1:605 S CONROE MEDICAL DR
Practice Address - Street 2:LONE STAR FAMILY HEALTH CENTER
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4722
Practice Address - Country:US
Practice Address - Phone:936-523-5292
Practice Address - Fax:936-521-8450
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX252461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry