Healthcare Provider Details

I. General information

NPI: 1831666940
Provider Name (Legal Business Name): DAVID R HENDRICK DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 10/26/2018
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: 980-729-5200
  • Fax: 704-434-4878
Mailing address:
  • Phone: 980-729-5200
  • Fax: 704-434-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DAVID R HENDRICK
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 704-434-4876