Organization
MYRON HENRICKSON, DDS PA
Active
Other names
Henrickson Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MYRON A HENRICKSON (OWNER)
(651) 777-8900
Entity
Organization
Contact information
Practice address
1560 BEAM AVE, SUITE 2, MAPLEWOOD, MN 55109-1191
(651) 777-8900
Mailing address
1560 BEAM AVE, SUITE 2, MAPLEWOOD, MN 55109-1191
(651) 777-8900
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9492
MN
Other
Enumeration date
07/17/2008
Last updated
07/17/2008
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