Tyler Jensen Hendry, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

55384 Issued in CA

Practice address

411 N Central Ave
Suite 220
Glendale, CA 91203-2081

Phone

(818) 240-4555

NPI assigned

Jul 7, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215388800000",
    "number": "1285897660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 N CENTRAL AVE",
            "address_2": "SUITE 220",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032081",
            "telephone_number": "818-240-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 N CENTRAL AVE",
            "address_2": "SUITE 220",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032081",
            "telephone_number": "818-240-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRY",
        "first_name": "TYLER",
        "middle_name": "JENSEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-07",
        "last_updated": "2008-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "55384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508873167",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Helping Hands Medical Equipment Inc
• Helping Hearts Hospice Care Inc
• Hemodialysis, Inc.
• Hemodialysis, Inc.
• Eli Edward Hendel, MD
• Henna Kim Dental Corp.
• Bryson T Hennington
• Arsine Echighian Henry, M.D.
• James Henry, M.D.
• Tamika Henry, M.D.

• Periodontics in Glendale, CA
• Providers in Glendale, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.