Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DS031646L | PA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS031646L | PA |
NPI | 1962473702 |
---|---|
Provider Name | Dr. Daniel Pearson Henrichsen |
First Address | Lancaster, PA 17603 |
Second Address | Lancaster, PA 17603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1014911850001 | (05) | PA |
32271 | BLUE SHIELD ID NUMBER (01) | PA |
DS031646L | DENTAL LICENSE NUMBER (01) | PA |
V04456 | (02) | PA |