MEDICARE: DR. ERIK WILLIAM MARKSBERRY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D11789	MN

General Provider Information

NPI Number	:	1124017603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIK WILLIAM MARKSBERRY D.D.S.

Provider Business Mailing Address
First Line	:	10756 BUTTERNUT ST NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-4448
Country	:	US
Telephone Number	:	763-757-4170
Fax Number	:	763-757-7940

Provider Business Practice Location Address
First Line	:	10756 BUTTERNUT ST NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-4448
Country	:	US
Telephone Number	:	763-757-4170
Fax Number	:	763-757-7940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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