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NPI 1962767004

NPI 1962767004 : ERICA KIGHT DDS : WHEATON, IL

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General NPI Number Information
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    NPI Number           |    1962767004
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    Entity Type          |    Individual 
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    Provider Name        |    ERICA KIGHT DDS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    07/04/2012
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    Last Update Date     |    11/14/2019
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Provider Practice Location Address
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    Address Line         |    1425 N MAIN ST 
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    City                 |    WHEATON
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    State                |    IL
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    Zip                  |    60187
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    Country              |    US
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    Telephone            |    630-923-8800
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    Fax                  |    630-923-8800
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Provider Business Mailing Address
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    Address Line         |    1425 N MAIN ST 
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    City                 |    WHEATON
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    State                |    IL
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    Zip                  |    60187-3581
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    Country              |    US
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    Telephone            |    630-923-8800
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    Fax                  |    630-923-8800
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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        |    122300000X
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    Taxonomy Name        |    Dentist
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    License Number       |    019029083
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    License Number State |    IL
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