# LEO S. HENRICHSEN,D.D.S., P.S

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972713972
- **Authorized official:** LEO S HENRICHSEN DDS,PS (PRESIDENT)
- **Authorized official phone:** (206) 364-7181

## Contact information

- **Practice address:** 5723 NE BOTHELL WAY STE D, KENMORE, WA 98028-9404
- **Practice address phone:** (206) 364-7181
- **Practice address fax:** (425) 483-6056
- **Mailing address:** 5723 NE BOTHELL WAY STE D, KENMORE, WA 98028-9404
- **Mailing address phone:** (206) 364-7181
- **Mailing address fax:** (425) 483-6056

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 3280 | WA | Yes |

## Other

- **Enumeration date:** 05/22/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01131 | WASHINGTON DENTAL SERVICE | WA |
| 05 | — | 5113105 | — | WA |