Provider Demographics
NPI:1992922066
Name:ANDERSON, ERICK TREVOR (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:TREVOR
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:STE 302
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5702
Mailing Address - Country:US
Mailing Address - Phone:719-593-0988
Mailing Address - Fax:719-598-7279
Practice Address - Street 1:3505 AUSTIN BLUFFS PKWY
Practice Address - Street 2:STE 302
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5702
Practice Address - Country:US
Practice Address - Phone:719-593-0988
Practice Address - Fax:719-598-7279
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice