Heath Hendrickson MBR

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5136599922 Issued in UT

Legal business name

HEATH HENDRICKSON MBR

Doing business as

Wisdom Teeth Only

Practice address

2230 N University Pkwy Ste 8a
Provo, UT 84604-6702

Phone

(801) 370-0050

NPI assigned

Jul 2, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Raymond Heath Hendrickson, DDS

Title

Owner

Phone

(801) 370-0050

Specialties & licenses 1

Addresses

Other names 1

• Wisdom Teeth Only Doing business as

Tax ID family

Dr Heath Hendrickson3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Dr. Heath Hendrickson

  • Dentist
  • Provo, UT
  • NPI 1912212895
  NPD tax ID
• Wisdom Teeth Only

  • Dentist
  • Provo, UT
  • NPI 1528518909
  NPD tax ID

Locations

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

{
    "created_epoch": "1341187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341187200000",
    "number": "1083978316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 N UNIVERSITY PKWY STE 8A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046702",
            "telephone_number": "801-370-0050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 N UNIVERSITY PKWY STE 8A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046702",
            "telephone_number": "801-370-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEATH HENDRICKSON MBR",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-02",
        "last_updated": "2012-07-02",
        "status": "A",
        "authorized_official_last_name": "HENDRICKSON",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "HEATH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-370-0050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "5136599922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wisdom Teeth Only",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Health Clinics of Utah
• Healthcare Medical Supply Inc
• Carrie Ellen Healy, STUDENT AND HEALTH
• Ted Joseph Heap
• Laura E Heaphy
• Heather Harrison, D.O., PLLC
• Dakota Wendel Heaton, DPT
• Tresa Heaton
• Wayne R Heaton, APRN
• Crystal A. Heer, L.P.C.

• General Practice Dentistry in Provo, UT
• Providers in Provo, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; 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.