Provider Demographics
NPI:1053525543
Name:HENDRICKS, MISTY JILL (DDS)
Entity type:Individual
Prefix:MS
First Name:MISTY
Middle Name:JILL
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MISTY
Other - Middle Name:JILL
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8605 CAMINO MEDIA STE 100
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1359
Mailing Address - Country:US
Mailing Address - Phone:661-664-1814
Mailing Address - Fax:661-664-0129
Practice Address - Street 1:8605 CAMINO MEDIA STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1359
Practice Address - Country:US
Practice Address - Phone:661-664-1814
Practice Address - Fax:661-664-0129
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist