Provider Demographics
NPI:1538200555
Name:ERICKSON, DOUGLAS M (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:324 W SUPERIOR ST
Mailing Address - Street 2:SUITE 1212
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1701
Mailing Address - Country:US
Mailing Address - Phone:218-722-8118
Mailing Address - Fax:218-726-9089
Practice Address - Street 1:324 W SUPERIOR ST
Practice Address - Street 2:SUITE 1212
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1701
Practice Address - Country:US
Practice Address - Phone:218-722-8118
Practice Address - Fax:218-726-9089
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND98921223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics