Provider Demographics
NPI:1316755648
Name:HENSON FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:HENSON FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REECE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-588-0578
Mailing Address - Street 1:6230 HIGHLAND PLACE WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4037
Mailing Address - Country:US
Mailing Address - Phone:865-588-0578
Mailing Address - Fax:
Practice Address - Street 1:6230 HIGHLAND PLACE WAY STE 202
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4037
Practice Address - Country:US
Practice Address - Phone:865-588-0578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental