Provider Demographics
NPI:1346680261
Name:PRACH, ERIN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MARIE
Last Name:PRACH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N ASH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1876
Mailing Address - Country:US
Mailing Address - Phone:307-337-4770
Mailing Address - Fax:307-337-4768
Practice Address - Street 1:130 N ASH ST STE 202
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1876
Practice Address - Country:US
Practice Address - Phone:307-337-4770
Practice Address - Fax:307-337-4768
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist