Provider Demographics
NPI:1124877626
Name:OOSTERHOFF, ERICA (DDS)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:OOSTERHOFF
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 1:1800 S 8000E RD
Mailing Address - Street 2:
Mailing Address - City:MOMENCE
Mailing Address - State:IL
Mailing Address - Zip Code:60954-3868
Mailing Address - Country:US
Mailing Address - Phone:815-573-3619
Mailing Address - Fax:
Practice Address - Street 1:806 E WALNUT ST STE B
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1585
Practice Address - Country:US
Practice Address - Phone:815-432-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program