Provider Demographics
NPI:1497029201
Name:HENDRICKS FAMILY & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:HENDRICKS FAMILY & COSMETIC DENTISTRY
Other - Org Name:DON MICHAEL HENDRICKS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DON MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-368-8618
Mailing Address - Street 1:1025 DOVE RUN RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3588
Mailing Address - Country:US
Mailing Address - Phone:859-368-8618
Mailing Address - Fax:859-368-8648
Practice Address - Street 1:1025 DOVE RUN RD
Practice Address - Street 2:SUITE 208
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3588
Practice Address - Country:US
Practice Address - Phone:859-368-8618
Practice Address - Fax:859-368-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty