MEDICARE: DR. JOELLE L.M HENDRICKSON-HAIRSTON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7136	NC
2	1223G0001X	General Practice Dentistry	0401412630	VA

General Provider Information

NPI Number	:	1407833809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOELLE L.M HENDRICKSON-HAIRSTON DDS

Provider Business Mailing Address
First Line	:	8105 HELMSDALE CT
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-6644
Country	:	US
Telephone Number	:	912-661-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 BIG BETHEL RD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1901
Country	:	US
Telephone Number	:	757-838-5999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	04/08/2022

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