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General NPI Number Information
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NPI Number | 1821789462
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Entity Type | Organization
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Legal Business Name | TODD M HENDRICKSON DMD PLLC
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 4949 PROFESSIONAL PARK DR STE 203
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City | KANNAPOLIS
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State | NC
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Zip | 28081-8638
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Country | US
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Telephone | 704-938-0559
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Fax | 888-651-3483
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Provider Business Mailing Address
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Address Line | 4949 PROFESSIONAL PARK DR STE 203
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City | KANNAPOLIS
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State | NC
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Zip | 28081-8638
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Country | US
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Telephone | 704-938-0559
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Fax | 888-651-3483
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | TODD MATTHEW HENDRICKSON
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Credential | DMD
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Telephone | 704-938-0559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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