| Michael Henrickson DDS | |
|
14050 Nicollet Ave Ste 205 Burnsville MN 55337-5738 | |
| (952) 435-4177 | |
| Not Available |
| Full Name | Michael Henrickson DDS |
|---|---|
| Speciality | Clinic/Center |
| Location | 14050 Nicollet Ave Ste 205, Burnsville, Minnesota |
| Authorized Official Name and Position | Mike Ryan Henrickson (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 6517778900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Henrickson DDS 1560 Beam Ave Ste A Maplewood MN 55109-1171 | Michael Henrickson DDS 14050 Nicollet Ave Ste 205 Burnsville MN 55337-5738 Ph: (952) 435-4177 |
| NPI Number | 1992571293 |
|---|---|
| Provider Enumeration Date | 11/28/2023 |
| Last Update Date | 11/28/2023 |
| Certification Date | 11/28/2023 |
| Medicare PECOS PAC ID | 4385087907 |
|---|---|
| Medicare Enrollment ID | O20240216001765 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992571293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Primary |
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