Provider Demographics
NPI:1083926356
Name:ERICKSON, JEFFREY HILDOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HILDOR
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 1:3201 W WALTER WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-1079
Mailing Address - Country:US
Mailing Address - Phone:319-331-3337
Mailing Address - Fax:
Practice Address - Street 1:6701 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:602-843-0100
Practice Address - Fax:602-843-5554
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10370122300000X
AZD0100801223G0001X
IA08719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist