Provider Demographics
NPI:1083876247
Name:HENDRICKS, DON-MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DON-MICHAEL
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 DOVE RUN RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3588
Mailing Address - Country:US
Mailing Address - Phone:859-368-8618
Mailing Address - Fax:859-368-8648
Practice Address - Street 1:1025 DOVE RUN RD
Practice Address - Street 2:SUITE 208
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3588
Practice Address - Country:US
Practice Address - Phone:859-368-8618
Practice Address - Fax:859-368-8648
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86241223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100070750Medicaid