Provider Demographics
NPI:1063610442
Name:ERASO ORTHODONTICS, INC.
Entity type:Organization
Organization Name:ERASO ORTHODONTICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:ERASO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-850-4500
Mailing Address - Street 1:11485 MONON FARMS LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3304
Mailing Address - Country:US
Mailing Address - Phone:317-850-4500
Mailing Address - Fax:317-865-7070
Practice Address - Street 1:11485 MONON FARMS LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3304
Practice Address - Country:US
Practice Address - Phone:317-850-4500
Practice Address - Fax:317-865-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010967A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12010967AOtherIN LICENSE
IN12010967AOtherIN LICENSE