Healthcare Provider Details

I. General information

NPI: 1649229808
Provider Name (Legal Business Name): GERRI L HENDON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GERRI L BROCK

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E TUSKEENA ST
HAYNEVILLE AL
36040-2666
US

IV. Provider business mailing address

PO BOX 70365
MONTGOMERY AL
36107-0365
US

V. Phone/Fax

Practice location:
  • Phone: 334-548-2516
  • Fax: 334-420-0160
Mailing address:
  • Phone: 334-296-6670
  • Fax: 334-293-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4623
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: