Healthcare Provider Details

I. General information

NPI: 1164234845
Provider Name (Legal Business Name): ALAN D. ERICKSON, D.D.S., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15955 85 NE ST
REDMOND WA
98052-3550
US

IV. Provider business mailing address

16410 SMOKEY POINT BLVD STE 107
ARLINGTON WA
98223-8415
US

V. Phone/Fax

Practice location:
  • Phone: 360-322-6934
  • Fax:
Mailing address:
  • Phone: 360-322-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ALAN D ERICKSON
Title or Position: OWNER
Credential:
Phone: 425-330-9959