Provider Demographics
NPI:1033448451
Name:HANCOCK, WENDY M (RDH)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:M
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRODIE LN
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8478
Mailing Address - Country:US
Mailing Address - Phone:229-382-9878
Mailing Address - Fax:229-382-9878
Practice Address - Street 1:274 WHITTLE CIR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-1918
Practice Address - Country:US
Practice Address - Phone:229-567-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH010828124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist