Provider Demographics
NPI:1831666940
Name:DAVID R HENDRICK DDS PA
Entity Type:Organization
Organization Name:DAVID R HENDRICK DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-434-4876
Mailing Address - Street 1:613 MCBRAYER HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-9536
Mailing Address - Country:US
Mailing Address - Phone:980-729-5200
Mailing Address - Fax:704-434-4878
Practice Address - Street 1:613 MCBRAYER HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-9536
Practice Address - Country:US
Practice Address - Phone:980-729-5200
Practice Address - Fax:704-434-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty