Provider Demographics
NPI:1053836288
Name:MACIAS-SERNA, ERIKA (DMD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:MACIAS-SERNA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W US ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-8942
Mailing Address - Country:US
Mailing Address - Phone:815-942-0010
Mailing Address - Fax:815-942-0692
Practice Address - Street 1:1010 W US ROUTE 6
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-8942
Practice Address - Country:US
Practice Address - Phone:815-942-0010
Practice Address - Fax:815-942-0692
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist