Provider Demographics
NPI:1093377368
Name:HENSLEY, JULAINE MAE (CRDH)
Entity type:Individual
Prefix:
First Name:JULAINE
Middle Name:MAE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:JULAINE
Other - Middle Name:MAE
Other - Last Name:MOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRDH
Mailing Address - Street 1:125 PEPPER CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-1176
Mailing Address - Country:US
Mailing Address - Phone:325-271-2550
Mailing Address - Fax:
Practice Address - Street 1:697 LOUISIANA RD BLDG 9201
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79607-1141
Practice Address - Country:US
Practice Address - Phone:325-696-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH26754124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist