Provider Demographics
NPI:1730376195
Name:HENSON, SCOTT THOMAS
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:THOMAS
Last Name:HENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:THOMAS
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MSD
Mailing Address - Street 1:29585 SW PARK PL
Mailing Address - Street 2:STE F
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6879
Mailing Address - Country:US
Mailing Address - Phone:503-547-3242
Mailing Address - Fax:
Practice Address - Street 1:29585 SW PARK PL
Practice Address - Street 2:STE F
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6879
Practice Address - Country:US
Practice Address - Phone:503-547-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist