Healthcare Provider Details

I. General information

NPI: 1841821238
Provider Name (Legal Business Name): DAVID HENDRICK DDS PLLC IV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 E MORGAN ST
WADESBORO NC
28170-2202
US

IV. Provider business mailing address

8604 CLIFF CAMERON DR STE 170
CHARLOTTE NC
28269-8508
US

V. Phone/Fax

Practice location:
  • Phone: 980-729-5200
  • Fax:
Mailing address:
  • Phone: 980-729-5200
  • Fax:

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 RAY HENDRICK
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 980-729-5200