Provider Demographics
NPI:1689876542
Name:HENDRICKSON, BILLY G (DDS,MSD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:G
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 MIDWESTERN PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2300
Mailing Address - Country:US
Mailing Address - Phone:940-691-2911
Mailing Address - Fax:940-691-4240
Practice Address - Street 1:2211 MIDWESTERN PKWY STE 1
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2300
Practice Address - Country:US
Practice Address - Phone:940-691-2911
Practice Address - Fax:940-691-4240
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics