Individual
BRETT A HENRIKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2 EXECUTIVE DR STE A, LAFAYETTE, IN 47905-4859
(765) 807-0230
(765) 807-0234
Mailing address
2 EXECUTIVE DR STE A, LAFAYETTE, IN 47905-4859
(765) 807-0230
(765) 807-0234
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12010155A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200471200
—
IN
Enumeration date
05/17/2007
Last updated
02/24/2011
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