Provider Demographics
NPI:1164676615
Name:GARDEN,DEST & HENDRICK,DDS, PLLC
Entity Type:Organization
Organization Name:GARDEN,DEST & HENDRICK,DDS, PLLC
Other - Org Name:DEST FAMILY DENTISTRY OF SALISBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-790-4402
Mailing Address - Street 1:201 MCCULLOUGH DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3577
Mailing Address - Country:US
Mailing Address - Phone:704-790-4402
Mailing Address - Fax:844-965-9171
Practice Address - Street 1:140 MAHALEY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2449
Practice Address - Country:US
Practice Address - Phone:704-637-0150
Practice Address - Fax:704-637-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52831223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty