Provider Demographics
NPI:1124332580
Name:BOOTH, ERICA L (DDS)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:L
Last Name:BOOTH
Suffix:
Gender:F
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:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-0536
Mailing Address - Country:US
Mailing Address - Phone:740-695-5400
Mailing Address - Fax:740-695-4998
Practice Address - Street 1:47301 NATIONAL RD W
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8712
Practice Address - Country:US
Practice Address - Phone:740-695-5400
Practice Address - Fax:740-695-4998
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300232291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice