Provider Demographics
NPI:1447496476
Name:HENSLEY PEDIATRIC DENTISTRY, INC.
Entity type:Organization
Organization Name:HENSLEY PEDIATRIC DENTISTRY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-641-3455
Mailing Address - Street 1:1010 VALLEY ST STE 113
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-2070
Mailing Address - Country:US
Mailing Address - Phone:937-641-3455
Mailing Address - Fax:937-641-5448
Practice Address - Street 1:1010 VALLEY ST STE 113
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-2070
Practice Address - Country:US
Practice Address - Phone:937-641-3455
Practice Address - Fax:937-641-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH218551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH188168619Medicaid