Provider Demographics
NPI:1336322023
Name:PEDDICORD, ERIKA ELLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:ELLEN
Last Name:PEDDICORD
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 1:3720 N ANKENY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4605
Mailing Address - Country:US
Mailing Address - Phone:515-963-3339
Mailing Address - Fax:515-963-0044
Practice Address - Street 1:3720 N ANKENY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4605
Practice Address - Country:US
Practice Address - Phone:515-963-3339
Practice Address - Fax:515-963-0044
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice