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NPI Code Detail

MEDICARE: DR. RICHARD H. ERICKSON DDS

MEDICARE:  DR. RICHARD H. ERICKSON  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
1122300000XDentistDN008854GA

General Provider Information

NPI Number : 1982855094
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD H. ERICKSON DDS
Provider Business Mailing Address
First Line : 4338 HIGHBORNE DR NE
Second Line :
City : MARIETTA
State : GA
Zip : 30066-2429
Country : US
Telephone Number : 770-973-0496
Fax Number : 770-973-4638
Provider Business Practice Location Address
First Line : 3823 ROSWELL RD
Second Line : SUITE 104
City : MARIETTA
State : GA
Zip : 30062-6278
Country : US
Telephone Number : 770-973-0496
Fax Number : 770-973-0496
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2008
Last Update Date : 10/07/2008

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Directions to “ DR. RICHARD H. ERICKSON DDS” Practice Location

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