Provider Demographics
NPI:1902982044
Name:HENDRIX, KEITH F (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:F
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 SOUTHWEST DR STE B
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5812
Mailing Address - Country:US
Mailing Address - Phone:870-935-6140
Mailing Address - Fax:870-935-9840
Practice Address - Street 1:521 SOUTHWEST DR STE B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5812
Practice Address - Country:US
Practice Address - Phone:870-935-6140
Practice Address - Fax:870-935-9840
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59392OtherBLUE CROSS BLUE SHIELD
AR831488OtherUNITED CONCORDIA