MEDICARE: NOAH MITCHELL HENRICHSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D15462	MN

General Provider Information

NPI Number	:	1598698367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOAH MITCHELL HENRICHSEN

Provider Business Mailing Address
First Line	:	10729 TOWN SQUARE DR NE STE 150
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55449-7924
Country	:	US
Telephone Number	:	763-269-8650
Fax Number	:	763-201-3377

Provider Business Practice Location Address
First Line	:	10729 TOWN SQUARE DR NE STE 150
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55449-7924
Country	:	US
Telephone Number	:	763-269-8650
Fax Number	:	763-201-3377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ NOAH MITCHELL HENRICHSEN ” Practice Location

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