1649229808 NPI number — GERRI L HENDON DMD

Table of content: GERRI L HENDON DMD (NPI 1649229808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649229808 NPI number — GERRI L HENDON DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDON
Provider First Name:
GERRI
Provider Middle Name:
L
Provider Name Prefix Text:
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:
BROCK
Provider Other First Name:
GERRI
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649229808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70365
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36107-0365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-296-6670
Provider Business Mailing Address Fax Number:
334-293-6676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 E TUSKEENA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYNEVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36040-2666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-548-2516
Provider Business Practice Location Address Fax Number:
334-420-0160
Provider Enumeration Date:
05/08/2006

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:  4623 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51517498 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 630902051 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 630901051 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6309000051 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51517455 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51077830 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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