| Henricksen Family Dental | |
|
1292 S Market Blvd Chehalis WA 98532-3645 | |
| (360) 748-4481 | |
| (360) 740-7542 |
| Full Name | Henricksen Family Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1292 S Market Blvd, Chehalis, Washington |
| Authorized Official Name and Position | Daniel M Henricksen (DENTIST/OWNER) |
| Authorized Official Contact | 3607484481 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Henricksen Family Dental 1292 S Market Blvd Chehalis WA 98532-3645 Ph: (360) 748-4481 | Henricksen Family Dental 1292 S Market Blvd Chehalis WA 98532-3645 Ph: (360) 748-4481 |
| NPI Number | 1821410663 |
|---|---|
| Provider Enumeration Date | 01/14/2014 |
| Last Update Date | 04/29/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821410663 | NPI | - | NPPES |
| 2043379 | Medicaid | WA | |
| 5334800 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 5334800 (Washington) | Primary |
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