Individual
KELLY HENDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1439 S SAINT FRANCIS DR, SANTA FE, NM 87505
(505) 473-5437
Mailing address
1439 S SAINT FRANCIS DR, SANTA FE, NM 87505-4037
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
D10994
OR
1223P0221X
Pediatric Dentistry
Primary
DD4219
NM
Other
Enumeration date
01/13/2014
Last updated
05/02/2019
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