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General NPI Number Information
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NPI Number | 1871831412
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Entity Type | Individual
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Provider Name | GLENN HENDRIX D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 2113 GOVERNMENT ST STE K1
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3949
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Country | US
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Telephone | 228-826-3811
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Fax |
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Provider Business Mailing Address
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Address Line | 2113 GOVERNMENT ST STE K1
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3949
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Country | US
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Telephone | 228-826-3811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3474-08
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License Number State | MS
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