Individual
DR. CHARLES VANCE HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
703 N MAIN ST, MT PLEASANT, TN 38474
(931) 379-7711
(931) 379-7729
Mailing address
PO BOX 232, MT PLEASANT, TN 38474
(931) 379-7711
(931) 379-7729
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS3102
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015890
BLUE CROSS BLUE SHIELD
TN
Enumeration date
08/19/2006
Last updated
07/08/2007
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