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General NPI Number Information
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NPI Number | 1952638488
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Entity Type | Organization
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Legal Business Name | LISA HENSON DMD LLC
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 1102 REGIS CT
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4404
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Country | US
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Telephone | 715-834-2032
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Fax | 715-552-1552
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Provider Business Mailing Address
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Address Line | 1102 REGIS CT
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4404
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Country | US
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Telephone | 715-834-2032
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Fax | 715-552-1552
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ELIZABETH P HENSON
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Credential | DMD
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Telephone | 715-834-2032
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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 | 5000361
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License Number State | WI
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