Healthcare Provider Details

I. General information

NPI: 1801963178
Provider Name (Legal Business Name): JEFFREY ERICKSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 12/23/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 NE 46TH STREET
FORT LAUNDERDALE FL
33308
US

IV. Provider business mailing address

3001 NE 46TH STREET
FORT LAUNDERDALE FL
33308
US

V. Phone/Fax

Practice location:
  • Phone: 954-958-9500
  • Fax:
Mailing address:
  • Phone: 954-958-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019015766
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: