Provider Demographics
NPI:1144822875
Name:HENSLEY, GLORIA BLAKE (DMD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:BLAKE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 STONEGATE DR APT C
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-1628
Mailing Address - Country:US
Mailing Address - Phone:606-309-6586
Mailing Address - Fax:
Practice Address - Street 1:1902 48TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3634
Practice Address - Country:US
Practice Address - Phone:334-756-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006829-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice