MEDICARE: HENDRICKS FAMILY DENTISTRY PC

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	122300000X	Dentist	0401005190	VA

General Provider Information

NPI Number	:	1790020238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENDRICKS FAMILY DENTISTRY PC

Provider Business Mailing Address
First Line	:	737 LITTLE NECK RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5813
Country	:	US
Telephone Number	:	757-486-4469
Fax Number	:

Provider Business Practice Location Address
First Line	:	737 LITTLE NECK RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5813
Country	:	US
Telephone Number	:	757-486-4469
Fax Number	:	757-486-4603

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ARTHUR CLAYBORN HENDRICKS
Credential	:	DDS
Telephone Number	:	757-486-4469

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	03/06/2013

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