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Individual

BRENT JASON HENRIKSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D., D.D.S.

Contact information

Practice address
1700 S. SOUTHEASTERN AVE., RIVER RIDGE ORAL AND MAXILLOFACIAL SURGICAL CENTER, SIOUX FALLS, SD 57103
(605) 331-5059
(605) 275-6725
Mailing address
1700 S. SOUTHEASTERN AVE., RIVER RIDGE ORAL AND MAXILLOFACIAL SURGICAL CENTER, SIOUX FALLS, SD 57103
(605) 331-5059
(605) 275-6725

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6428
NE
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D0814
SD

Other

Enumeration date
03/29/2007
Last updated
07/25/2008
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