Provider Demographics
NPI:1992029102
Name:HAGSTROM DOSSI, ERIKA ANN (RDA)
Entity type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:ANN
Last Name:HAGSTROM DOSSI
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5426
Mailing Address - Country:US
Mailing Address - Phone:209-694-6296
Mailing Address - Fax:
Practice Address - Street 1:800 MORNING STAR DR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9260
Practice Address - Country:US
Practice Address - Phone:209-588-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39201126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant