Healthcare Provider Details

I. General information

NPI: 1831839398
Provider Name (Legal Business Name): ERICA MAIRE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 06/21/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 S VICTORIA AVE STE D
OXNARD CA
93030-8663
US

IV. Provider business mailing address

16641 MCCORMICK ST
ENCINO CA
91436-1017
US

V. Phone/Fax

Practice location:
  • Phone: 805-985-2400
  • Fax:
Mailing address:
  • Phone: 484-448-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN122736
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDDS109780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: