Individual
AMANDA HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
121 N MAIN ST, BRISTOW, OK 74010-2429
(918) 367-3361
(918) 367-7076
Mailing address
PO BOX 867, BRISTOW, OK 74010-0867
(918) 367-3361
(918) 367-7076
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5948
OK
Other
Enumeration date
06/29/2007
Last updated
01/29/2013
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