Healthcare Provider Details

I. General information

NPI: 1891956355
Provider Name (Legal Business Name): ERICA LEWIS MEAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 DUTCHMANS LN
EASTON MD
21601-3345
US

IV. Provider business mailing address

613 DUTCHMANS LN
EASTON MD
21601-3345
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-7575
  • Fax:
Mailing address:
  • Phone: 410-822-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13284
License Number StateMD

VIII. Authorized Official

Name: ERICA MICHELE LEWIS MEAD
Title or Position: PEDIATRIC DENTIST
Credential: DDS
Phone: 410-822-7575