# BRADLEY J HENKENIUS, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Village Dental Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548737208
- **Authorized official:** DR. BRADLEY J HENKENIUS DDS (OWNER/PRESIDENT)
- **Authorized official phone:** (928) 774-0181

## Contact information

- **Practice address:** 710 N BEAVER ST BLDG 1, FLAGSTAFF, AZ 86001-3100
- **Practice address phone:** (928) 774-0181
- **Practice address fax:** (928) 774-7510
- **Mailing address:** 710 N BEAVER ST BLDG 1, FLAGSTAFF, AZ 86001-3100
- **Mailing address phone:** (928) 774-0181
- **Mailing address fax:** (928) 774-7510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/30/2018
- **Last updated:** 10/30/2018