Individual
DR. MATTHEW HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8980 HUDSON BLVD N, LAKE ELMO, MN 55042-9704
(651) 735-9057
Mailing address
8980 HUDSON BLVD N, LAKE ELMO, MN 55042-9704
(651) 735-9057
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12263
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137739600
—
MN
Enumeration date
12/15/2006
Last updated
07/21/2022
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