Healthcare Provider Details

I. General information

NPI: 1578524872
Provider Name (Legal Business Name): GRETCHEN KATHLEEN HENSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 E. 2ND ST NCAH HEUSER PEDIATRIC DENTAL SUITE 300 - DENTAL
SCOTTSDALE AZ
85251
US

IV. Provider business mailing address

525 W. CYPRESS
PHOENIX AZ
85003
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4388
  • Fax: 480-946-6997
Mailing address:
  • Phone: 646-543-7362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number055939
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD4933
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: