Healthcare Provider Details

I. General information

NPI: 1295265080
Provider Name (Legal Business Name): JOSEPH ERICKSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
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

125 EAGLES POINTE PKWY STE 220
STOCKBRIDGE GA
30281-6379
US

V. Phone/Fax

Practice location:
  • Phone: 706-884-0049
  • Fax: 706-884-2634
Mailing address:
  • Phone: 770-474-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN122837
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: