Individual
MR. RONALD GAIL HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
128 SOUTH ADAMS, JEROME, ID 83338
(208) 324-3596
Mailing address
56 EAST 100 SOUTH, JEROME, ID 83338
(208) 324-3596
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1554
ID
Other
Enumeration date
12/19/2006
Last updated
07/08/2007
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