Provider Demographics
NPI:1699824151
Name:HENSHAW, ROBERT S (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:HENSHAW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11786 SW BARNES RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5925
Mailing Address - Country:US
Mailing Address - Phone:503-531-3550
Mailing Address - Fax:503-531-3560
Practice Address - Street 1:11786 SW BARNES RD
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5925
Practice Address - Country:US
Practice Address - Phone:503-531-3550
Practice Address - Fax:503-531-3560
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD77141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics