Provider Demographics
NPI:1124032628
Name:HENDRICK, DAVID R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:HENDRICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 MCBRAYER HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-9536
Mailing Address - Country:US
Mailing Address - Phone:704-434-4876
Mailing Address - Fax:704-434-4878
Practice Address - Street 1:613 MCBRAYER HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-9536
Practice Address - Country:US
Practice Address - Phone:704-434-4876
Practice Address - Fax:704-434-4878
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC6442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993801Medicaid