Provider Demographics
NPI:1790020238
Name:HENDRICKS FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:HENDRICKS FAMILY DENTISTRY PC
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE, PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:CLAYBORN
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-486-4469
Mailing Address - Street 1:737 LITTLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5813
Mailing Address - Country:US
Mailing Address - Phone:757-486-4469
Mailing Address - Fax:
Practice Address - Street 1:737 LITTLE NECK RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5813
Practice Address - Country:US
Practice Address - Phone:757-486-4469
Practice Address - Fax:757-486-4603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-11
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty