MEDICARE: DR. DAVID CHRISTOPHER HENSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	18806	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	978542	OTHER	TX	UNITED CONCORDIA PROVIDER

General Provider Information

NPI Number	:	1467444034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CHRISTOPHER HENSON D.D.S.

Provider Business Mailing Address
First Line	:	4333 COLLEGE HILLS BLVD
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6919
Country	:	US
Telephone Number	:	325-944-2569
Fax Number	:

Provider Business Practice Location Address
First Line	:	4333 COLLEGE HILLS BLVD
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6919
Country	:	US
Telephone Number	:	325-944-2569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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