Provider Demographics
NPI:1841421260
Name:HENSON, ELIZABETH PHILIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:PHILIP
Last Name:HENSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 REGIS CT
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4404
Mailing Address - Country:US
Mailing Address - Phone:715-834-2032
Mailing Address - Fax:
Practice Address - Street 1:1102 REGIS CT
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4404
Practice Address - Country:US
Practice Address - Phone:715-834-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6436-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist