Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DD2013 | NM |
NPI | 1043348246 |
---|---|
Provider Name | Dr. Claudia Gail Von Hendricks |
First Address | Polacca, AZ 86042-0335 |
Second Address | Polacca, AZ 86042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
436148 | (05) | AZ |
VO5825 | (02) | AZ |