Provider Demographics
NPI:1497972434
Name:HENRIOD, JOEL B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:B
Last Name:HENRIOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 N HILL AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1905
Mailing Address - Country:US
Mailing Address - Phone:626-796-5386
Mailing Address - Fax:626-793-1534
Practice Address - Street 1:72 N HILL AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1905
Practice Address - Country:US
Practice Address - Phone:626-796-5386
Practice Address - Fax:626-793-1534
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics