Healthcare Provider Details

I. General information

NPI: 1760868343
Provider Name (Legal Business Name): KERRI ANN HENDRICKSEN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST SUITE 2307
SAN FRANCISCO CA
94108-4206
US

IV. Provider business mailing address

3221 BRODERICK ST
SAN FRANCISCO CA
94123-1810
US

V. Phone/Fax

Practice location:
  • Phone: 415-404-6644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number27017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: