Provider Demographics
NPI:1427134402
Name:HENDRICKS, WILLIAM SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SCOTT
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1178
Mailing Address - Street 2:140 GRAND TRUNK AVE.
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632
Mailing Address - Country:US
Mailing Address - Phone:330-877-9281
Mailing Address - Fax:330-877-3579
Practice Address - Street 1:140 GRAND TRUNK AVE.
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632
Practice Address - Country:US
Practice Address - Phone:330-877-9281
Practice Address - Fax:330-877-3579
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice