Active NPI
Brian Phillip Hendrickson, D.M.D.
- General Practice Dentistry
- Conifer, CO
National Provider Identifier
1598730855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6202
- Practice address
- 11804 Cochise Cir
Conifer, CO 80433-7114 - Phone
- (303) 838-7150
- Fax
- (720) 293-9687
- NPI assigned
- Feb 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6202 | CO | Primary |
Addresses
Primary practice location
11804 Cochise Cir
Conifer, CO 80433-7114
Mailing address
11804 Cochise Cir
Conifer, CO 80433-7114
Phone (303) 838-7150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6202 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376870400000",
"number": "1598730855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11804 COCHISE CIR",
"city": "CONIFER",
"state": "CO",
"postal_code": "804337114",
"telephone_number": "303-838-7150",
"fax_number": "720-293-9687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11804 COCHISE CIR",
"city": "CONIFER",
"state": "CO",
"postal_code": "804337114",
"telephone_number": "303-838-7150",
"fax_number": "720-293-9687"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDRICKSON",
"first_name": "BRIAN",
"middle_name": "PHILLIP",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-21",
"last_updated": "2013-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "6202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conifer, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.