Provider Demographics
NPI:1346410008
Name:JOSEPH R. HENDRICK, JR. DDS, PA
Entity Type:Organization
Organization Name:JOSEPH R. HENDRICK, JR. DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-484-0077
Mailing Address - Street 1:511 N MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4436
Mailing Address - Country:US
Mailing Address - Phone:704-484-0077
Mailing Address - Fax:704-482-2229
Practice Address - Street 1:511 N MORGAN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4436
Practice Address - Country:US
Practice Address - Phone:704-484-0077
Practice Address - Fax:704-482-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-08
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993792Medicaid