Myron A Henrickson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D9492 Issued in MN

Practice address

17436 Kenwood TRL
Lakeville, MN 55044

Phone

(952) 241-5899

Fax

(952) 241-5897

NPI assigned

Apr 11, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• PDG, P.a.

  dba Park Dental

  • Dental Clinic/Center
  • Lakeville, MN
  • NPI 1205265535
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532563200000",
    "number": "1023231776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 COUNTY ROAD C W STE 2210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132551",
            "telephone_number": "952-241-5899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17436 KENWOOD TRL",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "55044",
            "telephone_number": "952-241-5899",
            "fax_number": "952-241-5897"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17436 Kenwood Trl",
            "address_purpose": "LOCATION",
            "city": "Lakeville",
            "state": "MN",
            "postal_code": "550449219",
            "country_code": "US",
            "telephone_number": "952-241-5899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENRICKSON",
        "first_name": "MYRON",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2018-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D9492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandi Lynn Heinz
• Lindsay Helms
• Anna Helseth
• David Jerome Hemingway
• Chase Alden Hemme
• Cathy A Henry, LICSW
• Dianne M Henschel, LMFT
• Jessica Herigstad Farber, M.T.
• Heritage Commons Assisted Living LLC (BeeHive Homes of Lakeville)
• Melissa G Herzig, M.S.CCC

• General Practice Dentistry in Lakeville, MN
• Providers in Lakeville, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.