Healthcare Provider Details

I. General information

NPI: 1730866773
Provider Name (Legal Business Name): HENRICKSEN-HOLDINGS COLUMBUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 BETHEL RD STE 240
COLUMBUS OH
43220-1815
US

IV. Provider business mailing address

1960 BETHEL RD STE 240
COLUMBUS OH
43220-1815
US

V. Phone/Fax

Practice location:
  • Phone: 614-333-9442
  • Fax:
Mailing address:
  • Phone: 614-333-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW WALKER
Title or Position: AGENT
Credential:
Phone: 801-550-6421