Provider Demographics
NPI:1578900601
Name:HENDRICKSON, GENA (DDS)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:
Other - Last Name:MCGIVERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2235 SW WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-1945
Mailing Address - Country:US
Mailing Address - Phone:785-272-3722
Mailing Address - Fax:
Practice Address - Street 1:2235 SW WESTPORT DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-1945
Practice Address - Country:US
Practice Address - Phone:785-272-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS607791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics