Provider Demographics
NPI:1356469746
Name:BOONE AND COCQUYT LLC DBA ERSKINE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BOONE AND COCQUYT LLC DBA ERSKINE FAMILY DENTISTRY
Other - Org Name:ERSKINE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:K
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-299-9300
Mailing Address - Street 1:734 E IRELAND RD
Mailing Address - Street 2:ERSKINE FAMILY DENTISTRY
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-2662
Mailing Address - Country:US
Mailing Address - Phone:574-299-9300
Mailing Address - Fax:574-299-9853
Practice Address - Street 1:734 E IRELAND RD
Practice Address - Street 2:ERSKINE FAMILY DENTISTRY
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-2662
Practice Address - Country:US
Practice Address - Phone:574-299-9300
Practice Address - Fax:574-299-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090041223G0001X
IN120095531223G0001X
IN120100481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty