Provider Demographics
NPI:1821789462
Name:TODD M HENDRICKSON DMD PLLC
Entity Type:Organization
Organization Name:TODD M HENDRICKSON DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-938-0559
Mailing Address - Street 1:4949 PROFESSIONAL PARK DR STE 203
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-8638
Mailing Address - Country:US
Mailing Address - Phone:704-938-0559
Mailing Address - Fax:888-651-3483
Practice Address - Street 1:4949 PROFESSIONAL PARK DR STE 203
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-8638
Practice Address - Country:US
Practice Address - Phone:704-938-0559
Practice Address - Fax:888-651-3483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental