Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 9729 | TX |
NPI | 1003026972 |
---|---|
Provider Name | Dr. John Bernard Erickson |
First Address | Venus, TX 76084-3325 |
Second Address | Venus, TX 76084-3325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 11/06/2014 |