Provider Demographics
NPI:1215340880
Name:ERIKS DENTAL, PC
Entity type:Organization
Organization Name:ERIKS DENTAL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ERIKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-659-4977
Mailing Address - Street 1:1338 S LEBANON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-2792
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1338 S LEBANON ST STE 100
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2792
Practice Address - Country:US
Practice Address - Phone:765-659-4977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIKS DENTAL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-11
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010984A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty