Provider Demographics
NPI:1760510002
Name:HEDRICK, DARRELL W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:W
Last Name:HEDRICK
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 1:2001 LA QUESTA DR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-2846
Mailing Address - Country:US
Mailing Address - Phone:417-451-3545
Mailing Address - Fax:
Practice Address - Street 1:2001 LA QUESTA DR
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-2846
Practice Address - Country:US
Practice Address - Phone:417-451-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149031223G0001X
LA35131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice