Provider Demographics
NPI:1689786253
Name:HENDRICKSON, LENNARD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LENNARD
Middle Name:A
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22315 91ST PL SW
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-7072
Mailing Address - Country:US
Mailing Address - Phone:206-463-9058
Mailing Address - Fax:206-463-1494
Practice Address - Street 1:9873 BRIDGEPORT WAY SW
Practice Address - Street 2:SUITE #A
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2895
Practice Address - Country:US
Practice Address - Phone:253-582-8712
Practice Address - Fax:253-582-8713
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000034691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice