Healthcare Provider Details

I. General information

NPI: 1124031380
Provider Name (Legal Business Name): TODD OLIVER ERHARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 JACKSON CROSSING MALL
JACKSON MI
49202
US

IV. Provider business mailing address

1054 JACKSON CROSSING MALL
JACKSON MI
49202
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-9140
  • Fax: 517-788-7797
Mailing address:
  • Phone: 517-788-9140
  • Fax: 517-788-7797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901017002
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: