Organization
DANIEL M. HENRICKSEN DDS MS PLLC
Active
Other names
Henricksen Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL M HENRICKSEN D.D.S, M.S (DENTIST/OWNER)
(360) 748-4481
Entity
Organization
Contact information
Practice address
1292 S MARKET BLVD, CHEHALIS, WA 98532-3645
(360) 748-4481
(360) 740-7542
Mailing address
1292 S MARKET BLVD, CHEHALIS, WA 98532-3645
(360) 748-4481
(360) 740-7542
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5334800
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2043379
—
WA
05
—
5334800
—
WA
Enumeration date
01/14/2014
Last updated
04/29/2015
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