MEDICARE: ALAN D ERICKSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE00007950	WA

General Provider Information

NPI Number	:	1063521888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN D ERICKSON D.D.S.

Provider Business Mailing Address
First Line	:	16410 SMOKEY POINT BLVD
Second Line	:	STE 107
City	:	ARLINGTON
State	:	WA
Zip	:	98223-8415
Country	:	US
Telephone Number	:	360-322-6934
Fax Number	:	360-454-0471

Provider Business Practice Location Address
First Line	:	16410 SMOKEY POINT BLVD
Second Line	:	STE 107
City	:	ARLINGTON
State	:	WA
Zip	:	98223-8415
Country	:	US
Telephone Number	:	360-322-6934
Fax Number	:	360-454-0471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	12/15/2016

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