Daniel M. Henricksen DDS Ms PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

5334800 Issued in WA

Legal business name

DANIEL M. HENRICKSEN DDS MS PLLC

Doing business as

Henricksen Family Dental

Practice address

1292 S Market Blvd
Chehalis, WA 98532-3645

Phone

(360) 748-4481

Fax

(360) 740-7542

NPI assigned

Jan 14, 2014

Organization subpart

No

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

Authorized official

Name

Daniel M Henricksen, D.D.S, M.S

Title

Dentist/Owner

Phone

(360) 748-4481

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Henricksen Family Dental Doing business as

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

{
    "created_epoch": "1389657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430265600000",
    "number": "1821410663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 S MARKET BLVD",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985323645",
            "telephone_number": "360-748-4481",
            "fax_number": "360-740-7542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1292 S MARKET BLVD",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985323645",
            "telephone_number": "360-748-4481",
            "fax_number": "360-740-7542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL M. HENRICKSEN DDS MS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-14",
        "last_updated": "2015-04-29",
        "status": "A",
        "authorized_official_last_name": "HENRICKSEN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "360-748-4481",
        "authorized_official_credential": "D.D.S, M.S"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "5334800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2043379",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5334800",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henricksen Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary L Dahlstrom, CCC - SLP
• Cara Rae Dalrymple, RN
• Elsa S Daly, PEER SPECIALIST
• Daniela Margarethe Dandridge, PHARM.D.
• Robert Dandy
• Natalia M Davila, PNP APRN RN
• Gillian A Davis, RN
• Lisa Diane Davis, LPN
• Jessie Deal
• Ezekiel VK Deena

• Dental Clinic/Center in Chehalis, WA
• Providers in Chehalis, WA by specialty
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2015; 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.