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General NPI Number Information
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NPI Number | 1316719438
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Entity Type | Organization
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Legal Business Name | HENDRICKS CA DENTAL GROUP, INC
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 3661 TORRANCE BLVD STE 105
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City | TORRANCE
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State | CA
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Zip | 90503-4881
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Country | US
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Telephone | 310-543-3292
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Fax |
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Provider Business Mailing Address
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Address Line | 25 TEDDY BEAR TRL
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City | SANTA FE
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State | NM
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Zip | 87505-8118
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Country | US
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Telephone | 505-603-6595
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | GINNA HENDRICKS
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Credential | MBA
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Telephone | 505-603-6220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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