Provider Demographics
NPI:1164804548
Name:DEROUIN, ERIKA ROSE (DDS)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:ROSE
Last Name:DEROUIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:ROSE
Other - Last Name:GUETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:40520 COUNTY HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:OGEMA
Mailing Address - State:MN
Mailing Address - Zip Code:56569-9612
Mailing Address - Country:US
Mailing Address - Phone:218-983-4300
Mailing Address - Fax:218-983-6284
Practice Address - Street 1:40520 COUNTY HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:OGEMA
Practice Address - State:MN
Practice Address - Zip Code:56569-9612
Practice Address - Country:US
Practice Address - Phone:218-983-4300
Practice Address - Fax:218-983-6284
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND135661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice