Provider Demographics
NPI:1013006006
Name:ERICKSON, MICHAEL JOHN (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27684 ELDERBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2541
Mailing Address - Country:US
Mailing Address - Phone:951-698-7604
Mailing Address - Fax:
Practice Address - Street 1:1010 E VISTA WAY
Practice Address - Street 2:SUITE A & B
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4607
Practice Address - Country:US
Practice Address - Phone:760-940-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics