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General NPI Number Information
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NPI Number | 1578947008
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Entity Type | Individual
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Provider Name | MOLLY ANN ERDMAN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 3001 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 224-610-3426
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Fax |
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Provider Business Mailing Address
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Address Line | 4215 CATTAIL RUN APT. #410
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City | GURNEE
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State | IL
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Zip | 60031-9612
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Country | US
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Telephone | 507-351-3483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | D13541
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License Number State | MN
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