Provider Demographics
NPI:1437129632
Name:HENDRIX, PENELOPE CHRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:CHRIS
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:HENDRIX
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9612 CENTER CROSS CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7611
Mailing Address - Country:US
Mailing Address - Phone:919-845-5622
Mailing Address - Fax:
Practice Address - Street 1:9612 CENTER CROSS CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7611
Practice Address - Country:US
Practice Address - Phone:919-845-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN104141223G0001X
AL39081223G0001X
NC81321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice