Healthcare Provider Details

I. General information

NPI: 1124032628
Provider Name (Legal Business Name): DAVID R HENDRICK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 MCBRAYER HOMESTEAD RD
SHELBY NC
28152-9536
US

IV. Provider business mailing address

613 MCBRAYER HOMESTEAD RD
SHELBY NC
28152-9536
US

V. Phone/Fax

Practice location:
  • Phone: 704-434-4876
  • Fax: 704-434-4878
Mailing address:
  • Phone: 704-434-4876
  • Fax: 704-434-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberNC6442
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: