Provider Demographics
NPI:1427173152
Name:HENDRICKS, PAUL EUGENE JR (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EUGENE
Last Name:HENDRICKS
Suffix:JR
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 1:203 JUNIPER STREET
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3220
Mailing Address - Country:US
Mailing Address - Phone:704-739-7588
Mailing Address - Fax:704-739-4352
Practice Address - Street 1:203 JUNIPER STREET
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3220
Practice Address - Country:US
Practice Address - Phone:704-739-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993746Medicaid
NC8993746Medicaid