Organization
HENDRICKS PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA SHELTON (DENTIST)
(502) 314-3330
Entity
Organization
Contact information
Practice address
1557 WINDVIEW, BROWNSBURG, IN 46112-7641
(502) 314-3330
Mailing address
1557 WINDVIEW, BROWNSBURG, IN 46112-7641
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194160267
NPI TYPE 1
—
01
—
12012911A
IN DENTAL LICENSE
IN
05
—
201375550
—
IN
Enumeration date
10/16/2019
Last updated
10/16/2019
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