Healthcare Provider Details

I. General information

NPI: 1750773776
Provider Name (Legal Business Name): HENRIOD AND PAPWORTH DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40250 MURRIETA HOT SPRINGS RD SUITE 119
MURRIETA CA
92563-4961
US

IV. Provider business mailing address

40250 MURRIETA HOT SPRINGS RD SUITE 119
MURRIETA CA
92563-4961
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-4426
  • Fax: 951-698-7570
Mailing address:
  • Phone: 951-698-4426
  • Fax: 951-698-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39843
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number55124
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number39843
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL HENRIOD
Title or Position: BUSINESS MANAGER
Credential:
Phone: 951-698-4426