Provider Demographics
NPI:1861738973
Name:COVINGTON FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:COVINGTON FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-375-7326
Mailing Address - Street 1:4168 BAKER ST NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-1404
Mailing Address - Country:US
Mailing Address - Phone:770-787-2230
Mailing Address - Fax:
Practice Address - Street 1:4168 BAKER ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1404
Practice Address - Country:US
Practice Address - Phone:770-787-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty