Provider Demographics
NPI:1386606101
Name:CARLGREN, ERICK F (DDS)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:F
Last Name:CARLGREN
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 1:2 CALLE MEDICO
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4785
Mailing Address - Country:US
Mailing Address - Phone:505-982-4592
Mailing Address - Fax:505-982-1612
Practice Address - Street 1:2 CALLE MEDICO
Practice Address - Street 2:SUITE 3
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4785
Practice Address - Country:US
Practice Address - Phone:505-982-4592
Practice Address - Fax:505-982-1612
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM14291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics