Provider Demographics
NPI:1013120245
Name:HENDRICKSON, RAYMOND K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:K
Last Name:HENDRICKSON
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 1:140 E 200 N
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2144
Mailing Address - Country:US
Mailing Address - Phone:435-896-6444
Mailing Address - Fax:
Practice Address - Street 1:140 E 200 N
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2144
Practice Address - Country:US
Practice Address - Phone:435-896-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist