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General NPI Number Information
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NPI Number | 1831839398
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Entity Type | Individual
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Provider Name | ERICA MAIRE DMD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2022
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 480 S VICTORIA AVE STE D
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City | OXNARD
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State | CA
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Zip | 93030-8663
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Country | US
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Telephone | 805-985-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 16641 MCCORMICK ST
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City | ENCINO
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State | CA
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Zip | 91436-1017
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Country | US
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Telephone | 484-448-0008
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN122736
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DDS109780
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License Number State | CA
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