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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