Healthcare Provider Details

I. General information

NPI: 1154231702
Provider Name (Legal Business Name): JOSEPH ERICKSON DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

104 OLD MILL RD
LAGRANGE GA
30241-6704
US

IV. Provider business mailing address

104 OLD MILL RD
LAGRANGE GA
30241-6704
US

V. Phone/Fax

Practice location:
  • Phone: 706-884-0049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ERICKSON
Title or Position: OWNER/ORTHODONTIST
Credential: DDS
Phone: 208-550-3129