Provider Demographics
NPI:1972806008
Name:ERIKSEN, SOOJIN JESSICA (DMD)
Entity type:Individual
Prefix:DR
First Name:SOOJIN
Middle Name:JESSICA
Last Name:ERIKSEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1662
Mailing Address - Country:US
Mailing Address - Phone:508-393-6160
Mailing Address - Fax:
Practice Address - Street 1:1 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1662
Practice Address - Country:US
Practice Address - Phone:508-393-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-11
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH37411223G0001X
MADN1855584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice