MEDICARE: JENNIFER HENLEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4884	LA

General Provider Information

NPI Number	:	1841416781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HENLEY DDS

Provider Business Mailing Address
First Line	:	PO BOX 70
Second Line	:
City	:	HODGE
State	:	LA
Zip	:	71247-0070
Country	:	US
Telephone Number	:	318-251-0334
Fax Number	:	318-255-3538

Provider Business Practice Location Address
First Line	:	900 S VIENNA ST
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-5830
Country	:	US
Telephone Number	:	318-251-0334
Fax Number	:	318-255-3538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	11/11/2025

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