Provider Demographics
NPI:1063396430
Name:HENSON, CAROLINE ELAINE (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ELAINE
Last Name:HENSON
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 1:431 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-5234
Mailing Address - Country:US
Mailing Address - Phone:609-709-1708
Mailing Address - Fax:
Practice Address - Street 1:4258 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3820
Practice Address - Country:US
Practice Address - Phone:863-937-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist