Provider Demographics
NPI:1063507051
Name:FASS, ERICK L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:L
Last Name:FASS
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 1:2076 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3608
Mailing Address - Country:US
Mailing Address - Phone:954-432-5700
Mailing Address - Fax:954-432-0511
Practice Address - Street 1:2076 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3608
Practice Address - Country:US
Practice Address - Phone:954-432-5700
Practice Address - Fax:954-432-0511
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice