Healthcare Provider Details

I. General information

NPI: 1245154442
Provider Name (Legal Business Name): ERIE DENTAL PARTNERS PROF. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 MITCHELL WAY UNIT 170
ERIE CO
80516-5452
US

IV. Provider business mailing address

680 MITCHELL WAY UNIT 170
ERIE CO
80516-5452
US

V. Phone/Fax

Practice location:
  • Phone: 720-552-4970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JAROM PAICE
Title or Position: PARTNER
Credential: D.D.S.
Phone: 720-552-4970