Healthcare Provider Details

I. General information

NPI: 1265787287
Provider Name (Legal Business Name): GRAIG ERICKSON DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10814 19TH AVE SE
EVERETT WA
98208-5153
US

IV. Provider business mailing address

10814 19TH AVE SE
EVERETT WA
98208-5153
US

V. Phone/Fax

Practice location:
  • Phone: 425-337-4734
  • Fax:
Mailing address:
  • Phone: 425-337-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number60492562
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: