Provider Demographics
NPI:1548541477
Name:RICK HENSLEY DMD, PA DBA RICK HENSLEY FAMILY DENTISTRY
Entity type:Organization
Organization Name:RICK HENSLEY DMD, PA DBA RICK HENSLEY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD / DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-973-5060
Mailing Address - Street 1:181 MEDICAL CENTER ROAD
Mailing Address - Street 2:WEST WILKES MEDICAL CENTER
Mailing Address - City:FERGUSON
Mailing Address - State:NC
Mailing Address - Zip Code:28624-8925
Mailing Address - Country:US
Mailing Address - Phone:336-973-5060
Mailing Address - Fax:336-973-5150
Practice Address - Street 1:181 MEDICAL CENTER ROAD
Practice Address - Street 2:WEST WILKES MEDICAL CENTER
Practice Address - City:FERGUSON
Practice Address - State:NC
Practice Address - Zip Code:28624-8925
Practice Address - Country:US
Practice Address - Phone:336-973-5060
Practice Address - Fax:336-973-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899003YMedicaid