Provider Demographics
NPI:1306859590
Name:HENDREN, JOANNA M (RDH)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:HENDREN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:M
Other - Last Name:BROYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:PO DRAWER 367
Mailing Address - Street 2:111 BEVER GRADE ROAD
Mailing Address - City:LAPWAI
Mailing Address - State:ID
Mailing Address - Zip Code:83540-0367
Mailing Address - Country:US
Mailing Address - Phone:208-843-2271
Mailing Address - Fax:208-621-4995
Practice Address - Street 1:111 BEVER GRADE ROAD
Practice Address - Street 2:
Practice Address - City:LAPWAI
Practice Address - State:ID
Practice Address - Zip Code:83540-0367
Practice Address - Country:US
Practice Address - Phone:208-843-2271
Practice Address - Fax:208-621-4995
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDH1698124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist