Provider Demographics
NPI:1801013586
Name:HENDRIX, PHILLIP MELVIN JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:MELVIN
Last Name:HENDRIX
Suffix:JR
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 1:610 N ALMA SCHOOL ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3687
Mailing Address - Country:US
Mailing Address - Phone:480-461-8683
Mailing Address - Fax:480-964-4171
Practice Address - Street 1:610 N ALMA SCHOOL ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3687
Practice Address - Country:US
Practice Address - Phone:480-461-8683
Practice Address - Fax:480-964-4171
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ466541-01Medicaid