Provider Demographics
NPI:1750814612
Name:DENTAL OFFICE OF JOEL BARETT HENRIOD DDS INC.
Entity Type:Organization
Organization Name:DENTAL OFFICE OF JOEL BARETT HENRIOD DDS INC.
Other - Org Name:ALBION DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRIOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-792-7018
Mailing Address - Street 1:216 E ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6241
Mailing Address - Country:US
Mailing Address - Phone:626-335-0134
Mailing Address - Fax:
Practice Address - Street 1:216 E ROUTE 66
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6241
Practice Address - Country:US
Practice Address - Phone:626-335-0134
Practice Address - Fax:626-335-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty