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NPI Code Detail

MEDICARE: ERICA BOSWELL RDH

MEDICARE: ERICA BOSWELL RDH
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
1124Q00000XDental HygienistH05618AZ

General Provider Information

NPI Number : 1689522047
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA BOSWELL RDH
Provider Business Mailing Address
First Line : 2920 N 4TH ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-1816
Country : US
Telephone Number : 928-522-9400
Fax Number :
Provider Business Practice Location Address
First Line : 2920 N 4TH ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-1816
Country : US
Telephone Number : 928-522-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2026
Last Update Date : 03/20/2026

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Directions to “ ERICA BOSWELL RDH” Practice Location

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