Provider Demographics
NPI:1881974814
Name:HEDRICK, JOHN ANTHONY (DDS, MS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:HEDRICK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WATER ST
Mailing Address - Street 2:SUITE B2
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4124
Mailing Address - Country:US
Mailing Address - Phone:831-427-2822
Mailing Address - Fax:
Practice Address - Street 1:550 WATER ST
Practice Address - Street 2:SUITE B2
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4124
Practice Address - Country:US
Practice Address - Phone:831-427-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics