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General NPI Number Information
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NPI Number | 1730866773
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Entity Type | Organization
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Legal Business Name | HENRICKSEN-HOLDINGS COLUMBUS LLC
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Dates
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Enumeration Date | 06/30/2023
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 1960 BETHEL RD STE 240
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City | COLUMBUS
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State | OH
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Zip | 43220-1815
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Country | US
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Telephone | 614-333-9442
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Fax |
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Provider Business Mailing Address
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Address Line | 1960 BETHEL RD STE 240
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City | COLUMBUS
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State | OH
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Zip | 43220-1815
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Country | US
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Telephone | 614-333-9442
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Fax |
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Authorized Official
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Title or Position | AGENT
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Name | ANDREW WALKER
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Credential |
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Telephone | 801-550-6421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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