Healthcare Provider Details

I. General information

NPI: 1649674706
Provider Name (Legal Business Name): GRAIG ERICKSON, D.D.S., M.S.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2014
Last Update Date: 10/18/2014
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. GRAIG ERICKSON
Title or Position: PERIODONTIST
Credential: DDS, MSD
Phone: 425-337-4734