Provider Demographics
NPI:1528086428
Name:HENSLEY, RUFUS WADE (DMD, PA)
Entity type:Individual
Prefix:DR
First Name:RUFUS
Middle Name:WADE
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 BURKEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4501
Mailing Address - Country:US
Mailing Address - Phone:828-430-8334
Mailing Address - Fax:828-430-6997
Practice Address - Street 1:918 BURKEMONT AVE
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4501
Practice Address - Country:US
Practice Address - Phone:828-430-8334
Practice Address - Fax:828-430-6997
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC6676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899003YMedicaid