1215165873 NPI number — DR. MARTHA CLARK HENDRIX (DMD)

Table of content: DR. MARTHA CLARK HENDRIX (DMD) (NPI 1215165873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215165873 NPI number — DR. MARTHA CLARK HENDRIX (DMD)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDRIX
Provider First Name:
MARTHA
Provider Middle Name:
CLARK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
(DMD)
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215165873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1090 NORTHCHASE PARKWAY SE
Provider Second Line Business Mailing Address:
SUITE 290 KOOL SMILES/ NCDR, LLC
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-904-5665
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3112 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29621-2763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-716-2118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4610 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com