Provider Demographics
NPI:1477028462
Name:HENRICHSEN, DAVID SETH (RDH, OMT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SETH
Last Name:HENRICHSEN
Suffix:
Gender:M
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22922 13TH PL W
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9115
Mailing Address - Country:US
Mailing Address - Phone:425-343-8574
Mailing Address - Fax:
Practice Address - Street 1:22922 13TH PL W
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9115
Practice Address - Country:US
Practice Address - Phone:425-343-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00007772124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist