Provider Demographics
NPI:1053688895
Name:MATT HENDRICKSON PLLC
Entity Type:Organization
Organization Name:MATT HENDRICKSON PLLC
Other - Org Name:HERITAGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-542-4402
Mailing Address - Street 1:1434 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 121
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3106
Mailing Address - Country:US
Mailing Address - Phone:972-542-4402
Mailing Address - Fax:972-542-2553
Practice Address - Street 1:1434 N CENTRAL EXPY
Practice Address - Street 2:SUITE 121
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3106
Practice Address - Country:US
Practice Address - Phone:972-542-4402
Practice Address - Fax:972-542-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20486261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental