Active NPI
Charles Vance Hendrickson, DMD
- Dentist
- Mt Pleasant, TN
National Provider Identifier
1659485183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS3102
- Practice address
- 703 N Main St
Mt Pleasant, TN 38474 - Phone
- (931) 379-7711
- Fax
- (931) 379-7729
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS3102 | TN | Primary |
Addresses
Primary practice location
703 N Main St
Mt Pleasant, TN 38474
Mailing address
PO Box 232
Mt Pleasant, TN 38474
Phone (931) 379-7711
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0015890 | Other | TN | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS3102 | TN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael L. Tyler DDS | Past | Accepting new patients | |
| Tailwater Practice Partners | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Mt Pleasant, TN
- NPI 1083181531
-
dba Family Dentistry of Mt. Pleasant
- General Practice Dentistry
- Mt Pleasant, TN
- NPI 1366312027
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659485183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 232",
"city": "MT PLEASANT",
"state": "TN",
"postal_code": "38474",
"telephone_number": "931-379-7711",
"fax_number": "931-379-7729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "703 N MAIN ST",
"city": "MT PLEASANT",
"state": "TN",
"postal_code": "38474",
"telephone_number": "931-379-7711",
"fax_number": "931-379-7729"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDRICKSON",
"first_name": "CHARLES",
"middle_name": "VANCE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "DS3102",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0015890",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mt Pleasant, TN
- Diabetes Management Associates
- James Quinton Dickerson IV, PHARM.D
- Fast Pace Medical Clinic PLLC
- Fast Pace Medical Clinic, PLLC
- Trever Hawkins
- Hidden Acres Healthcare, LLC (Mt. Pleasant Health & Rehab Center)
- Mary Houston Hull, NP
- Kinzer Pharmacy, LLC (Kinzer Pharmacy)
- Michael Kinzer, DPH
- Maury Regional Hospital (Mt. Pleasant Primary Care Network)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.