Provider Demographics
NPI:1316232911
Name:HENRIKSEN, CODY LONNIE (DDS)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:LONNIE
Last Name:HENRIKSEN
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 1:1729 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2126
Mailing Address - Country:US
Mailing Address - Phone:605-339-1369
Mailing Address - Fax:605-334-5590
Practice Address - Street 1:1729 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2126
Practice Address - Country:US
Practice Address - Phone:605-339-1369
Practice Address - Fax:605-334-5590
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDTEMP 3361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice