Healthcare Provider Details

I. General information

NPI: 1497972434
Provider Name (Legal Business Name): JOEL B. HENRIOD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 N HILL AVE
PASADENA CA
91106-1905
US

IV. Provider business mailing address

72 N HILL AVE
PASADENA CA
91106-1905
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-5386
  • Fax: 626-793-1534
Mailing address:
  • Phone: 626-796-5386
  • Fax: 626-793-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number55124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: