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General NPI Number Information
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NPI Number | 1356469746
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Entity Type | Organization
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Legal Business Name | BOONE AND COCQUYT LLC DBA ERSKINE FAMILY DENTISTRY
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 734 E IRELAND RD ERSKINE FAMILY DENTISTRY
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City | SOUTH BEND
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State | IN
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Zip | 46614-2662
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Country | US
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Telephone | 574-299-9300
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Fax | 574-299-9853
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Provider Business Mailing Address
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Address Line | 734 E IRELAND RD ERSKINE FAMILY DENTISTRY
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City | SOUTH BEND
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State | IN
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Zip | 46614-2662
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Country | US
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Telephone | 574-299-9300
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Fax | 574-299-9853
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Authorized Official
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Title or Position | FINANCIAL MANAGER
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Name | MRS. BRIDGET K CLARK
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Credential |
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Telephone | 574-299-9300
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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 | 12009004
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12010048
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12009553
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License Number State | IN
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