Provider Demographics
NPI:1073639514
Name:ERICKSON, ALISHA (RDH)
Entity Type:Individual
Prefix:MS
First Name:ALISHA
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 WOLCOTT ST
Mailing Address - Street 2:BLDG 6 #10
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1326
Mailing Address - Country:US
Mailing Address - Phone:203-228-7413
Mailing Address - Fax:
Practice Address - Street 1:534 SHELTON AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-2804
Practice Address - Country:US
Practice Address - Phone:203-929-6338
Practice Address - Fax:203-929-7619
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006937124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist