Provider Demographics
NPI:1295038883
Name:ADRIENNE M. HEDRICK, DDS,PC
Entity Type:Organization
Organization Name:ADRIENNE M. HEDRICK, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-772-6333
Mailing Address - Street 1:2929 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-1600
Mailing Address - Country:US
Mailing Address - Phone:303-772-6333
Mailing Address - Fax:303-682-3001
Practice Address - Street 1:2929 17TH AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-1600
Practice Address - Country:US
Practice Address - Phone:303-772-6333
Practice Address - Fax:303-682-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN91861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty