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General NPI Number Information
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NPI Number | 1124293782
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Entity Type | Organization
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Legal Business Name | AUBREY J HENSHAW III
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 201 S OAK ST
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City | SALLISAW
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State | OK
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Zip | 74955-6209
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Country | US
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Telephone | 918-775-4431
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Fax | 918-775-4432
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Provider Business Mailing Address
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Address Line | PO BOX 708
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City | SALLISAW
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State | OK
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Zip | 74955-0708
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Country | US
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Telephone | 918-775-4431
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Fax | 918-775-4432
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Authorized Official
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Title or Position | DENTIST
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Name | AUBREY J HENSHAW
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Credential | DDS
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Telephone | 918-775-4431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 75227
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License Number State | OK
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