Provider Demographics
NPI:1962527598
Name:HENSLEY, JAMES MARTIN (DDS, FAGD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARTIN
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1693 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1628
Mailing Address - Country:US
Mailing Address - Phone:516-378-2345
Mailing Address - Fax:516-377-0335
Practice Address - Street 1:1693 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1628
Practice Address - Country:US
Practice Address - Phone:516-378-2345
Practice Address - Fax:516-377-0335
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0474541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice