Ivan K. Hendricksond.D.S.,inc
Dentist, General Practice in St George, UT. Organization (NPI-2).
NPI number1528092913
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1528092913
- Entity type
- Organization (NPI-2)
- Legal business name
- Ivan K. Hendricksond.D.S.,inc
- Organization subpart
- No
- Enumeration date
- Jul 10, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 3043 | UT | Yes |
Practice location
720 S River Rd Ste B210St George, UT 84790-5584
Phone 435-656-0507
Mailing address
720 S River Rd Ste B210St George, UT 84790-5584
Phone 435-656-0507
Authorized official
Ivan K Hendrickson
Dentist
4356560507
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