Provider Demographics
NPI:1215165873
Name:HENDRIX, MARTHA CLARK ((DMD))
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:CLARK
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:(DMD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 NORTHCHASE PARKWAY SE
Mailing Address - Street 2:SUITE 290 KOOL SMILES/ NCDR, LLC
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067
Mailing Address - Country:US
Mailing Address - Phone:678-904-5665
Mailing Address - Fax:
Practice Address - Street 1:3112 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2763
Practice Address - Country:US
Practice Address - Phone:864-716-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice