Provider Demographics
NPI:1053482505
Name:HENDRICKS, JAMES ROBERT (DMD,MPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:DMD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 WESTGATE CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8194
Mailing Address - Country:US
Mailing Address - Phone:615-373-9889
Mailing Address - Fax:615-425-0320
Practice Address - Street 1:1642 WESTGATE CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8194
Practice Address - Country:US
Practice Address - Phone:615-373-9889
Practice Address - Fax:615-425-0320
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN80551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics