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General NPI Number Information
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NPI Number | 1992441117
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Entity Type | Individual
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Provider Name | ERIKSON KARACHEBAN
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Gender | Male
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 250 E INTERNATIONAL SPEEDWAY BLVD
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City | DELAND
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State | FL
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Zip | 32724-2340
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Country | US
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Telephone | 386-626-3296
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 SW 66TH AVE APT 3302
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City | PORTLAND
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State | OR
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Zip | 97225-6025
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Country | US
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Telephone | 503-881-9361
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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 | 390200000X
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License Number State | FL
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