Healthcare Provider Details

I. General information

NPI: 1235925470
Provider Name (Legal Business Name): EVAN JOHN ERICKSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WALTERS DIVISION RD
MONROE NC
28110-8562
US

IV. Provider business mailing address

12951 BULLOCK GREENWAY BLVD
CHARLOTTE NC
28277-8195
US

V. Phone/Fax

Practice location:
  • Phone: 704-289-1105
  • Fax:
Mailing address:
  • Phone: 704-698-8307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14559
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11133
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: