Provider Demographics
NPI:1447590658
Name:SCOTT L. HENRIKSEN, DDS INC.
Entity Type:Organization
Organization Name:SCOTT L. HENRIKSEN, DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENRIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-733-2363
Mailing Address - Street 1:1112 N CHINOWTH ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-7896
Mailing Address - Country:US
Mailing Address - Phone:559-733-2363
Mailing Address - Fax:559-635-7766
Practice Address - Street 1:1112 N CHINOWTH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-7896
Practice Address - Country:US
Practice Address - Phone:559-733-2363
Practice Address - Fax:559-635-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty