Healthcare Provider Details

I. General information

NPI: 1043348246
Provider Name (Legal Business Name): CLAUDIA GAIL VON HENDRICKS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOPI HEALTH CARE CENTER HWY 264 MM 388
POLACCA AZ
86042
US

IV. Provider business mailing address

PO BOX 335
POLACCA AZ
86042-0335
US

V. Phone/Fax

Practice location:
  • Phone: 928-737-6160
  • Fax: 928-737-6168
Mailing address:
  • Phone: 928-737-6160
  • Fax: 928-737-6168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDD2013
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: