Michael Henrickson DDS

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MICHAEL HENRICKSON DDS

Doing business as

henrickson dental

Practice address

1560 Beam Ave Ste a
Maplewood, MN 55109-1171

Phone

(651) 777-8900

Fax

(651) 777-8908

NPI assigned

Jul 9, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Mike Ryan Henrickson, DDSNPI 1629291380

Title

Authorized Official

Phone

(651) 777-8900

Specialties & licenses 1

Addresses

Other names 1

• henrickson dental Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Michael Henrickson DDS

  • Dental Clinic/Center
  • Burnsville, MN
  • NPI 1992571293

  4385087907

  Same PAC ID

Tax ID family

Henrickson Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Michael Henrickson DDS

  • Dental Clinic/Center
  • Burnsville, MN
  • NPI 1992571293
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mike R Henrickson, DDS

  • General Practice Dentistry
  • Maplewood, MN
  • NPI 1629291380
  NPD Authorized official

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

{
    "created_epoch": "1562630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701129600000",
    "number": "1861054090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 BEAM AVE STE A",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091171",
            "telephone_number": "651-777-8900",
            "fax_number": "651-777-8908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 BEAM AVE STE A",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091171",
            "telephone_number": "651-777-8900",
            "fax_number": "651-777-8908"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14050 Nicollet Ave Ste 205",
            "address_purpose": "LOCATION",
            "city": "Burnsville",
            "state": "MN",
            "postal_code": "553375738",
            "country_code": "US",
            "telephone_number": "952-435-4177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MICHAEL HENRICKSON DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-09",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A",
        "authorized_official_last_name": "HENRICKSON",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "651-777-8900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@henricksondental.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1560 Beam Ave Ste A",
            "city": "Maplewood",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551091171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "henrickson dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "henrickson dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Metropolitan State University (Mertopolitan State University Dental Clinic)
• Brandi Sue Meyer, LAT,PTA
• Megan Meyer, M.D.T.
• Joan Mezera, RN MA APNP
• Mercy Miantona
• Jessica Michelle Michaud
• Lorianne M Michaud, OTRL
• Marina Midthun, CCC-SLP
• Peter Hermann Mielke, DDS
• Annette N Mies, MD

• Dental Clinic/Center in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.