Individual
DR. MIKE R HENRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1560 BEAM AVE, SUITE 2, MAPLEWOOD, MN 55109-1191
(651) 777-8900
(651) 777-8908
Mailing address
1560 BEAM AVE, SUITE 2, MAPLEWOOD, MN 55109-1191
(651) 777-8900
(651) 777-8908
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11920
MN
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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