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General NPI Number Information
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NPI Number | 1265440531
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Entity Type | Organization
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Legal Business Name | ERICKSON FAMILY DENTAL P.A.
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1726 UNIVERSITY AVE
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City | CROOKSTON
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State | MN
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Zip | 56716-1112
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Country | US
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Telephone | 218-281-4323
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Fax |
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Provider Business Mailing Address
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Address Line | 1726 UNIVERSITY AVE
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City | CROOKSTON
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State | MN
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Zip | 56716-1112
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Country | US
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Telephone | 218-281-4323
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. WILLIAM T. ERICKSON
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Credential | D.D.S.
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Telephone | 218-281-4323
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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 | 10020
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License Number State | MN
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