Michael Jon Hendrickson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4733-015 Issued in WI

Practice address

2121 S Webster Ave
Ste 1
Green Bay, WI 54301-2290

Phone

(920) 435-1998

Fax

(920) 435-1399

NPI assigned

Jul 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Webster Dental Associates, S.C.

  • Dentist
  • Green Bay, WI
  • NPI 1194859215
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881600161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 S WEBSTER AVE",
            "address_2": "STE 1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012290",
            "telephone_number": "920-435-1998",
            "fax_number": "920-435-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 S WEBSTER AVE",
            "address_2": "STE 1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012290",
            "telephone_number": "920-435-1998",
            "fax_number": "920-435-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKSON",
        "first_name": "MICHAEL",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4733-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helping Hands Caregivers, LLC
• Hemophilia Outreach of Wisconsin, Inc.
• Chase Hemphill, DO
• Allyson Hencke
• Kaela Marie Hendricks
• Jaden Hendzel, SAC-IT
• Kayla Martha Henkel, COTA
• Jasmin Henning
• Karl John Henrikson, MD
• Nicolena Hensler-Gordon, LPC

• General Practice Dentistry in Green Bay, WI
• Providers in Green Bay, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.