Healthcare Provider Details

I. General information

NPI: 1083661979
Provider Name (Legal Business Name): ERICKSON & GILL, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E LINCOLN AVE
WELLINGTON KS
67152-3045
US

IV. Provider business mailing address

122 E LINCOLN AVE
WELLINGTON KS
67152-3045
US

V. Phone/Fax

Practice location:
  • Phone: 620-326-5751
  • Fax: 620-326-7915
Mailing address:
  • Phone: 620-326-5751
  • Fax: 620-326-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ROXI HUTSLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 620-326-5751