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Organization
JON A. HENDRICKSON, DDS INC.
Active
Organization
JON A. HENDRICKSON, DDS INC.
Active
Other names
Trafalgar Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON AXBERG HENDRICKSON DDS (OWNER/PRESIDENT)
(317) 878-4990
Entity
Organization
Contact information
Practice address
245 N STATE ROAD 135, TRAFALGAR, IN 46181-8663
(317) 878-4990
(317) 878-9030
Mailing address
245 N STATE ROAD 135, TRAFALGAR, IN 46181-8663
(317) 878-4990
(317) 878-9030
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009969
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083628481
NATIONAL PROVIDER IDENTIFIER
IN
05
—
200183090A
—
IN
Enumeration date
06/16/2008
Last updated
06/16/2008
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