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General NPI Number Information
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NPI Number | 1023466299
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Entity Type | Organization
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Legal Business Name | HENDRICKS DENTAL STUDIO, PA
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Dates
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Enumeration Date | 05/29/2016
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Last Update Date | 05/29/2016
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Provider Practice Location Address
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Address Line | 3557 HENDRICKS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5309
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Country | US
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Telephone | 904-396-1023
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Fax |
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Provider Business Mailing Address
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Address Line | 3557 HENDRICKS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5309
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Country | US
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Telephone | 904-396-1023
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AZADEH YAVARI
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Credential | DDS
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Telephone | 904-396-1023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19121
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License Number State | FL
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