Jake Taylor Hendrickson

NPI #1235753344 in Fort Carson, Colorado

Provider Information

NPI Number: 1235753344
Entity Type: Individual
Name: Jake Taylor Hendrickson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dental Assistant
Enumeration Date: Jun 4, 2020
Last Updated: Jun 4, 2020

Practice Location

Address: 1667 COCHRANE CIR BLDG 7495
City: Fort Carson
State: Colorado
ZIP Code: 80913-4603
Phone: (719) 526-5537

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dental Assistant	126800000X	Primary

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