Provider Demographics
NPI:1790040467
Name:HENDRICKS, JULIE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:L
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 PARK ST
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-2050
Mailing Address - Country:US
Mailing Address - Phone:641-236-6174
Mailing Address - Fax:
Practice Address - Street 1:902 PARK ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2050
Practice Address - Country:US
Practice Address - Phone:641-236-6174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice