Organization
MICHAEL HENRICKSON DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE RYAN HENRICKSON DDS (AUTHORIZED OFFICIAL)
(651) 777-8900
Entity
Organization
Contact information
Practice address
14050 NICOLLET AVE STE 205, BURNSVILLE, MN 55337-5738
(952) 435-4177
Mailing address
1560 BEAM AVE STE A, MAPLEWOOD, MN 55109-1171
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/28/2023
Last updated
11/28/2023
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