1003960220 NPI number — DR. JOHN L HENSON DMD

Table of content: DR. JOHN L HENSON DMD (NPI 1003960220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003960220 NPI number — DR. JOHN L HENSON DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENSON
Provider First Name:
JOHN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003960220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
451 NORTH PARK DR #A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGELAND
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-957-7030
Provider Business Mailing Address Fax Number:
601-957-7732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 NORTH PARK DR #A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-957-7030
Provider Business Practice Location Address Fax Number:
601-957-7732
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2343-87 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 640764063 . This is a "E-CLAIMS NUMBER" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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