Provider Demographics
NPI:1346699311
Name:THOMAS E ERICKSEN, DDS, LLC
Entity Type:Organization
Organization Name:THOMAS E ERICKSEN, DDS, LLC
Other - Org Name:KAYSVILLE DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-540-6377
Mailing Address - Street 1:2325 W 525 S
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5534
Mailing Address - Country:US
Mailing Address - Phone:801-540-6377
Mailing Address - Fax:
Practice Address - Street 1:690 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-3132
Practice Address - Country:US
Practice Address - Phone:801-719-6621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5796632-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty