# DANIEL M. HENRICKSEN DDS MS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Henricksen Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821410663
- **Authorized official:** DANIEL M HENRICKSEN D.D.S, M.S (DENTIST/OWNER)
- **Authorized official phone:** (360) 748-4481

## Contact information

- **Practice address:** 1292 S MARKET BLVD, CHEHALIS, WA 98532-3645
- **Practice address phone:** (360) 748-4481
- **Practice address fax:** (360) 740-7542
- **Mailing address:** 1292 S MARKET BLVD, CHEHALIS, WA 98532-3645
- **Mailing address phone:** (360) 748-4481
- **Mailing address fax:** (360) 740-7542

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 5334800 | WA | Yes |

## Other

- **Enumeration date:** 01/14/2014
- **Last updated:** 04/29/2015