Active NPI
Michael Henrickson DDS
- Dental Clinic/Center
- Burnsville, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Clinic/Center
- Legal business name
- MICHAEL HENRICKSON DDS
- Practice address
- 14050 Nicollet Ave Ste 205
Burnsville, MN 55337-5738 - Phone
- (952) 435-4177
- NPI assigned
- Nov 28, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mike Ryan Henrickson, DDS
- Title
- Authorized Official
- Phone
- (651) 777-8900
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | Primary |
Addresses
Primary practice location
14050 Nicollet Ave Ste 205
Burnsville, MN 55337-5738
Mailing address
1560 Beam Ave Ste a
Maplewood, MN 55109-1171
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240216001765 | MN | DME Supplier - Oral Surgery - Dentist | 4385087907 | Practice locations: Burnsville, MN |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Henrickson Dental
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dental Clinic/Center
- Maplewood, MN
- NPI 1861054090
Locations
1560 Beam Ave
Ste A
Saint Paul, MN 55109
Phone (651) 777-0788
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- Maplewood, MN
- NPI 1629291380
-
- Dentist
- Maplewood, MN
- NPI 1770696387
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701129600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1701129600000",
"number": "1992571293",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14050 NICOLLET AVE STE 205",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553375738",
"telephone_number": "952-435-4177"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MICHAEL HENRICKSON DDS",
"organizational_subpart": "NO",
"enumeration_date": "2023-11-28",
"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_credential": "DDS"
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burnsville, MN
Sources for this page
- 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.