Organization
HEATH HENDRICKSON MBR
Active
Other names
Wisdom Teeth Only
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND HEATH HENDRICKSON DDS (OWNER)
(801) 370-0050
Entity
Organization
Contact information
Practice address
2230 N UNIVERSITY PKWY STE 8A, PROVO, UT 84604-6702
(801) 370-0050
Mailing address
2230 N UNIVERSITY PKWY STE 8A, PROVO, UT 84604-6702
(801) 370-0050
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5136599922
UT
Other
Enumeration date
07/02/2012
Last updated
07/02/2012
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