Provider Demographics
NPI:1417184045
Name:HENDRY, WILLIAM M (DOM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:HENDRY
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 N PLEASANTBURG DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4036
Mailing Address - Country:US
Mailing Address - Phone:864-365-6156
Mailing Address - Fax:
Practice Address - Street 1:1934 N PLEASANTBURG DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4036
Practice Address - Country:US
Practice Address - Phone:864-365-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2646171100000X
SCACUP141171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist