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General NPI Number Information
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NPI Number | 1487181723
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Entity Type | Organization
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Legal Business Name | ROBERT E. ERICKSON, DMD, PLLC
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12 STILLWATER AVE STE 6
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City | BANGOR
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State | ME
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Zip | 04401-3984
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Country | US
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Telephone | 207-992-2060
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Fax | 207-262-0424
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Provider Business Mailing Address
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Address Line | 12 STILLWATER AVE STE 6
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City | BANGOR
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State | ME
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Zip | 04401-3984
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Country | US
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Telephone | 207-992-2060
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Fax | 207-262-0424
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT E ERICKSON
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Credential | DMD
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Telephone | 207-992-2060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3214
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License Number State | ME
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