NPIMap

Organization Active NPI

Dr. Heath Hendrickson

Doing business as Wisdom Teeth Only

  • Dentist
  • Provo, UT
National Provider Identifier
1912212895
Registry record updated Aug 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
51365979922 Issued in UT
Legal business name
DR. HEATH HENDRICKSON
Doing business as
Wisdom Teeth Only
Practice address
2230 N University Pkwy
8A
Provo, UT 84604-1509
Phone
(801) 370-0050
Fax
(801) 370-9635
NPI assigned
Aug 16, 2010
Last updated
Aug 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2010

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

Authorized official

Name
Dr. Heath Hendrickson, DDS
Title
Owner
Phone
(801) 370-0050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 51365979922 UT Primary

Addresses

Primary practice location

2230 N University Pkwy
8A
Provo, UT 84604-1509

Mailing address

2230 N University Pkwy
8A
Provo, UT 84604-1509
Phone (801) 370-0050

Other identifiers 1

IdentifierTypeStateIssuer
HT000004-001MedicaidUT

Other names 1

  • Wisdom Teeth Only Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dr Heath Hendrickson3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

2230 N University Pkwy
Ste 8A
Provo, UT 84604
Phone (801) 370-0050

NPI Registry JSON

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

{
    "created_epoch": "1281916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281916800000",
    "number": "1912212895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 N UNIVERSITY PKWY",
            "address_2": "8A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041509",
            "telephone_number": "801-370-0050",
            "fax_number": "801-370-9635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 N UNIVERSITY PKWY",
            "address_2": "8A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041509",
            "telephone_number": "801-370-0050",
            "fax_number": "801-370-9635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. HEATH HENDRICKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-16",
        "last_updated": "2010-08-16",
        "status": "A",
        "authorized_official_last_name": "HENDRICKSON",
        "authorized_official_first_name": "HEATH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-370-0050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "51365979922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HT000004-001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wisdom Teeth Only",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2010; 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.