Healthcare Provider Details

I. General information

NPI: 1487403382
Provider Name (Legal Business Name): ERIKA KARJALAHTI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N HIGHBROOK WAY STE 102
STAR ID
83669-1029
US

IV. Provider business mailing address

2968 N BOULDER CREEK AVE
MERIDIAN ID
83646-7834
US

V. Phone/Fax

Practice location:
  • Phone: 208-600-0522
  • Fax:
Mailing address:
  • Phone: 651-447-0792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD-5618
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: