Provider Demographics
NPI:1962670349
Name:HENDI, JUSTIN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:A
Last Name:HENDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4910
Mailing Address - Country:US
Mailing Address - Phone:845-357-2070
Mailing Address - Fax:845-357-2144
Practice Address - Street 1:84 ROUTE 59
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4910
Practice Address - Country:US
Practice Address - Phone:845-357-2070
Practice Address - Fax:845-357-2144
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2564041223S0112X
NY0550251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery