Provider Demographics
NPI:1699122549
Name:ERICKSON, ADAM CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:CHARLES
Last Name:ERICKSON
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 1:26273 2ND ST E
Mailing Address - Street 2:P.O. BOX 448 - SUITE A
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-4743
Mailing Address - Country:US
Mailing Address - Phone:763-856-5100
Mailing Address - Fax:
Practice Address - Street 1:26273 2ND ST E
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-4743
Practice Address - Country:US
Practice Address - Phone:763-856-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist