Healthcare Provider Details

I. General information

NPI: 1235427493
Provider Name (Legal Business Name): TY ERIKS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 W WOOLBRIGHT RD
BOYNTON BEACH FL
33436-7245
US

IV. Provider business mailing address

3399 W WOOLBRIGHT RD
BOYNTON BEACH FL
33436-7245
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-4004
  • Fax:
Mailing address:
  • Phone: 561-733-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60228655
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN19397
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: