Provider Demographics
NPI:1205261385
Name:HENDRIKS, BRYAN HUBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:HUBERT
Last Name:HENDRIKS
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 1:306 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-6766
Mailing Address - Country:US
Mailing Address - Phone:801-631-3527
Mailing Address - Fax:
Practice Address - Street 1:306 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-6766
Practice Address - Country:US
Practice Address - Phone:801-631-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT83671551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice