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General NPI Number Information
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NPI Number | 1972782621
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC SPECIALISTS LLC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 640 EAST 700 SOUTH SUITE 301
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City | ST GEORGE
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State | UT
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Zip | 84770
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Country | US
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Telephone | 435-673-9661
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Fax | 435-673-6473
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Provider Business Mailing Address
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Address Line | 640 EAST 700 SOUTH SUITE 301
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City | ST GEORGE
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State | UT
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Zip | 84770
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Country | US
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Telephone | 435-673-9661
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Fax | 435-673-6473
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | DR. JEFF ERICKSON
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Credential |
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Telephone | 435-673-9661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1304029921
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 61864309921
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License Number State | UT
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