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General NPI Number Information
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NPI Number | 1679785307
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Entity Type | Individual
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Provider Name | JOHN LAZARUS HENSON III D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6500 COYLE AVE SUITE 7
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City | CARMICHAEL
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State | CA
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Zip | 95608-0301
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Country | US
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Telephone | 916-967-0092
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Fax | 916-967-7239
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Provider Business Mailing Address
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Address Line | 6500 COYLE AVE SUITE 7
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City | CARMICHAEL
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State | CA
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Zip | 95608-0301
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Country | US
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Telephone | 916-967-0092
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Fax | 916-967-7239
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 24795
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License Number State | CA
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