Provider Demographics
NPI:1649229808
Name:HENDON, GERRI L (DMD)
Entity type:Individual
Prefix:
First Name:GERRI
Middle Name:L
Last Name:HENDON
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:GERRI
Other - Middle Name:L
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 70365
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-0365
Mailing Address - Country:US
Mailing Address - Phone:334-296-6670
Mailing Address - Fax:334-293-6676
Practice Address - Street 1:511 E TUSKEENA ST
Practice Address - Street 2:
Practice Address - City:HAYNEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36040-2666
Practice Address - Country:US
Practice Address - Phone:334-548-2516
Practice Address - Fax:334-420-0160
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517498OtherBCBS
AL630902051Medicaid
AL630901051Medicaid
AL6309000051Medicaid
AL51517455OtherBCBS
AL51077830OtherBCBS
AL51517455OtherBCBS