Provider Demographics
NPI:1871831412
Name:HENDRIX, GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:HENDRIX
Suffix:
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 1:2113 GOVERNMENT ST STE K1
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3949
Mailing Address - Country:US
Mailing Address - Phone:228-826-3811
Mailing Address - Fax:
Practice Address - Street 1:2113 GOVERNMENT ST STE K1
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3949
Practice Address - Country:US
Practice Address - Phone:228-826-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3474-081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice