Provider Demographics
NPI:1093882136
Name:HENDRICKS, TAREM ERIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAREM
Middle Name:ERIC
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 1:98 COHEN WALKER DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-0744
Mailing Address - Country:US
Mailing Address - Phone:478-218-2000
Mailing Address - Fax:
Practice Address - Street 1:98 COHEN WALKER DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-0744
Practice Address - Country:US
Practice Address - Phone:478-218-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0123451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000982121BMedicaid