MEDICARE: TY ERIKS DMD

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	122300000X	Dentist	DE60228655	WA
2	1223G0001X	General Practice Dentistry	DN19397	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235427493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TY ERIKS DMD

Provider Business Mailing Address
First Line	:	3399 W WOOLBRIGHT RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-7245
Country	:	US
Telephone Number	:	561-733-4004
Fax Number	:

Provider Business Practice Location Address
First Line	:	3399 W WOOLBRIGHT RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-7245
Country	:	US
Telephone Number	:	561-733-4004
Fax Number	:

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

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	04/21/2026

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