Provider Demographics
NPI:1346467206
Name:ERICKSON, JOSHUA (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9334 GRAND CORDERA PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-7000
Mailing Address - Country:US
Mailing Address - Phone:719-439-9476
Mailing Address - Fax:
Practice Address - Street 1:9334 GRAND CORDERA PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7000
Practice Address - Country:US
Practice Address - Phone:719-282-6666
Practice Address - Fax:719-203-5477
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN 96651223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN390200000XOtherRESIDENT