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NPI Code Detail

MEDICARE: DR. ERIKA MARIE THEISEN DDS

MEDICARE: DR. ERIKA MARIE THEISEN DDS
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
11223G0001XGeneral Practice DentistryD12795MN

General Provider Information

NPI Number : 1083934905
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIKA MARIE THEISEN DDS
Provider Business Mailing Address
First Line : 22 2ND AVE S
Second Line :
City : SAUK RAPIDS
State : MN
Zip : 56379-1408
Country : US
Telephone Number : 320-252-7806
Fax Number : 320-252-9044
Provider Business Practice Location Address
First Line : 22 2ND AVE S
Second Line :
City : SAUK RAPIDS
State : MN
Zip : 56379-1408
Country : US
Telephone Number : 320-252-7806
Fax Number : 320-252-9044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2010
Last Update Date : 03/16/2016

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