Provider Demographics
NPI:1003026972
Name:ERICKSON, JOHN BERNARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BERNARD
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-3325
Mailing Address - Country:US
Mailing Address - Phone:972-366-3900
Mailing Address - Fax:972-366-3990
Practice Address - Street 1:206 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-3325
Practice Address - Country:US
Practice Address - Phone:972-366-3900
Practice Address - Fax:972-366-3990
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist