Organization
DENTURE PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EARL DOUGLAS HENSON (DENTIST)
(678) 937-9601
Entity
Organization
Contact information
Practice address
2258 NORTHLAKE PKWY STE 200, TUCKER, GA 30084-4018
(678) 937-9607
Mailing address
2258 NORTHLAKE PKWY STE 200, TUCKER, GA 30084-4018
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154490639
NPI
GA
01
—
1952470437
NPI
GA
Enumeration date
11/12/2007
Last updated
11/12/2007
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