Provider Demographics
NPI:1801229562
Name:GIDEON-HENSLEY, DENA (RDH)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:GIDEON-HENSLEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 SEAHORSE CT
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-1903
Mailing Address - Country:US
Mailing Address - Phone:559-706-0457
Mailing Address - Fax:
Practice Address - Street 1:1010 SHAW AVE STE B
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3950
Practice Address - Country:US
Practice Address - Phone:559-706-0457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21240124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21240OtherDENTAL PROVIDER