Ivan K Hendrickson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

143297 Issued in UT

Practice address

720 S River Rd Ste B210
St George, UT 84790-5584

Phone

(435) 656-0507

Fax

(435) 656-3791

NPI assigned

Jul 8, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362528000000",
    "number": "1003079260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 S RIVER RD STE B210",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847905584",
            "telephone_number": "435-656-0507",
            "fax_number": "435-656-3791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 S RIVER RD STE B210",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847905584",
            "telephone_number": "435-656-0507",
            "fax_number": "435-656-3791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKSON",
        "first_name": "IVAN",
        "middle_name": "K",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-08",
        "last_updated": "2013-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "143297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon David Henderson, D.M.D
• Brooklyn Elizabeth Henderson
• Terrie Henderson
• John Wilson Hendleman, DO
• Brian James Hendrickson
• Mackenzie Lyn Hendrickson, CM
• Jason W Hendrix, M.D.
• Stephanie Henrie, CMHC
• Gabriella Henry
• Therese Henry

• Dentist in St George, UT
• Providers in St George, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.