Provider Demographics
NPI:1831764471
Name:HENSLEY, CANDACE (DDS)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13052 JENNA CT
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8020
Mailing Address - Country:US
Mailing Address - Phone:812-219-3140
Mailing Address - Fax:
Practice Address - Street 1:2810 S WALNUT STREET PIKE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8403
Practice Address - Country:US
Practice Address - Phone:812-336-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013618A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist