Healthcare Provider Details

I. General information

NPI: 1841416781
Provider Name (Legal Business Name): JENNIFER HENLEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S VIENNA ST
RUSTON LA
71270-5830
US

IV. Provider business mailing address

PO BOX 70
HODGE LA
71247-0070
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-0334
  • Fax: 318-255-3538
Mailing address:
  • Phone: 318-251-0334
  • Fax: 318-255-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4884
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: