Provider Demographics
NPI:1770614349
Name:HENDRICKSEN, A. R (DDS)
Entity type:Individual
Prefix:DR
First Name:A.
Middle Name:R
Last Name:HENDRICKSEN
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 1:4901 MOUNTAIN LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-1972
Mailing Address - Country:US
Mailing Address - Phone:434-384-6900
Mailing Address - Fax:434-384-4964
Practice Address - Street 1:HWY 221-8642 FOREST RD
Practice Address - Street 2:
Practice Address - City:GOODE
Practice Address - State:VA
Practice Address - Zip Code:24556
Practice Address - Country:US
Practice Address - Phone:540-587-5707
Practice Address - Fax:540-587-5727
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA044261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice