Provider Demographics
NPI:1235427972
Name:HENDLEY, LA CHELLE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:LA CHELLE
Middle Name:J
Last Name:HENDLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 BLANDING BLVD
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5051
Mailing Address - Country:US
Mailing Address - Phone:772-349-3816
Mailing Address - Fax:
Practice Address - Street 1:410 BLANDING BLVD
Practice Address - Street 2:SUITE 6B
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5051
Practice Address - Country:US
Practice Address - Phone:772-349-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN194551223G0001X
SC86651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice