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General NPI Number Information
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NPI Number | 1245799956
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Entity Type | Organization
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Legal Business Name | TAD A ERICKSON DDS A DENTAL CORPORATION
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 346 KANAN RD STE 101
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City | OAK PARK
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State | CA
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Zip | 91377-1165
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Country | US
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Telephone | 818-889-2254
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Fax | 818-889-0636
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Provider Business Mailing Address
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Address Line | 346 KANAN RD STE 101
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City | OAK PARK
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State | CA
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Zip | 91377-1165
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Country | US
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Telephone | 818-889-2254
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Fax | 818-889-0636
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. TAD ERICKSON
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Credential | DDS
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Telephone | 818-889-2254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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