MEDICARE: GERRI L HENDON DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4623	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51517498	OTHER	AL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	51517455	OTHER	AL	BCBS
6	51077830	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1649229808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERRI L HENDON DMD

Provider Business Mailing Address
First Line	:	PO BOX 70365
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36107-0365
Country	:	US
Telephone Number	:	334-296-6670
Fax Number	:	334-293-6676

Provider Business Practice Location Address
First Line	:	511 E TUSKEENA ST
Second Line	:
City	:	HAYNEVILLE
State	:	AL
Zip	:	36040-2666
Country	:	US
Telephone Number	:	334-548-2516
Fax Number	:	334-420-0160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	03/26/2025

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