Provider Demographics
NPI:1124689328
Name:HENRIOD AND CHRISTENSEN DENTAL CORPORATION
Entity type:Organization
Organization Name:HENRIOD AND CHRISTENSEN DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
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 1:425 10TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-3936
Mailing Address - Country:US
Mailing Address - Phone:760-789-0170
Mailing Address - Fax:
Practice Address - Street 1:425 10TH ST STE B
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-3936
Practice Address - Country:US
Practice Address - Phone:760-789-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55124OtherCBDE