Provider Demographics
NPI:1346379476
Name:HEAD, ERIK ALLAN
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:ALLAN
Last Name:HEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BOLLINGER CANYON WAY # 8.5
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5251
Mailing Address - Country:US
Mailing Address - Phone:925-735-6190
Mailing Address - Fax:925-735-6198
Practice Address - Street 1:500 BOLLINGER CANYON WAY
Practice Address - Street 2:#8.5
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5251
Practice Address - Country:US
Practice Address - Phone:925-735-6190
Practice Address - Fax:925-735-6198
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist