Brent Jason Henriksen, M.D., D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

6428 Issued in NE

Practice address

1700 S. Southeastern Ave.
River Ridge Oral and Maxillofacial Surgical Center
Sioux Falls, SD 57103

Phone

(605) 331-5059

Fax

(605) 275-6725

NPI assigned

Mar 29, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 28, 2014 through Jun 28, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• River Ridge Oral & Maxillofacial Surgical Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Sioux Falls, SD
  • NPI 1376522714
  NPD (past)

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216944000000",
    "number": "1821118480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 S. SOUTHEASTERN AVE.",
            "address_2": "RIVER RIDGE ORAL AND MAXILLOFACIAL SURGICAL CENTER",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "57103",
            "telephone_number": "605-331-5059",
            "fax_number": "605-275-6725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 S. SOUTHEASTERN AVE.",
            "address_2": "RIVER RIDGE ORAL AND MAXILLOFACIAL SURGICAL CENTER",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "57103",
            "telephone_number": "605-331-5059",
            "fax_number": "605-275-6725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRIKSEN",
        "first_name": "BRENT",
        "middle_name": "JASON",
        "credential": "M.D., D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2008-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NE",
            "license": "6428",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SD",
            "license": "D0814",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Hendry, PHARM. D.
• Bradley Hennings
• Megan Teresa Henningsen, OTD OTRL
• Erika Henrich, RN
• Teresa M Henrickson, LPC MH
• Cody Lonnie Henriksen, DDS
• Anasara Henry, DNP, AGPCNP-BC
• Emily Henry, ED.S
• Jason D Henry, DC, CCSP
• Scott D Henry, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.