Provider Demographics
NPI:1063905388
Name:HOUCK, ERIK W (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:W
Last Name:HOUCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18701 IROQUOIS LN
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4457
Mailing Address - Country:US
Mailing Address - Phone:952-836-9646
Mailing Address - Fax:
Practice Address - Street 1:10700 FRANCE AVE S STE 102
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3693
Practice Address - Country:US
Practice Address - Phone:952-679-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND139981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice