| Doctor Name: | DR. KRISTIN WAYNE HENDRICKS |
| NPI Number: | 1023320165 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DDS |
| License Number: | DD3267 |
| Business Practice Address: | 2904 Rodeo Park Dr E Suite 300b Santa Fe, NM - 875056305 |
| Business Phone Number: | 5054735437 |
| Business Fax Number: | 5054383443 |
| Mailing Address: | 2904 Rodeo Park Dr E, Suite 300b SANTA FE |
| State: | NM |
| Postal Code: | 875056305 |
| Phone Number: | 5054735437 |
| Fax Number: | 5054383443 |
| NPI Enumeration Date: | 07/06/2010 |
| NPI Last Update Date: | 07/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | DD3267 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |