Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 8055 | TN |
NPI | 1053482505 |
---|---|
Provider Name | James Robert Hendricks |
First Address | Brentwood, TN 37027-8194 |
Second Address | Brentwood, TN 37027-8194 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 19/03/2009 |