MEDICARE: ROBERT B. HENSON DDS PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1871338525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT B. HENSON DDS PLLC

Provider Business Mailing Address
First Line	:	11441 OSAGE ST NW STE 2
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-3655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11441 OSAGE ST NW STE 2
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-3655
Country	:	US
Telephone Number	:	763-757-6600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT B HENSON
Credential	:
Telephone Number	:	701-552-2974

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	06/26/2024

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