Provider Demographics
NPI:1043348246
Name:VON HENDRICKS, CLAUDIA GAIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:GAIL
Last Name:VON HENDRICKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:POLACCA
Mailing Address - State:AZ
Mailing Address - Zip Code:86042-0335
Mailing Address - Country:US
Mailing Address - Phone:928-737-6160
Mailing Address - Fax:928-737-6168
Practice Address - Street 1:HOPI HEALTH CARE CENTER
Practice Address - Street 2:HWY 264 MM 388
Practice Address - City:POLACCA
Practice Address - State:AZ
Practice Address - Zip Code:86042
Practice Address - Country:US
Practice Address - Phone:928-737-6160
Practice Address - Fax:928-737-6168
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD20131223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ436148Medicaid
AZVO5825Medicare UPIN
AZ436148Medicaid