Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 1974 | ND |
N | 122300000X | Dentist | 5945-015 | WI |
N | 122300000X | Dentist | D12127 | MN |
NPI | 1013011451 |
---|---|
Provider Name | Dr. Christopher Algot Eriksson |
First Address | Grand Forks, ND 58201 |
Second Address | Grand Forks, ND 58201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 01/12/2014 |