Provider Demographics
NPI:1417133851
Name:ERICKSEN, DANA W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:W
Last Name:ERICKSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2709
Mailing Address - Country:US
Mailing Address - Phone:703-385-3226
Mailing Address - Fax:703-385-1472
Practice Address - Street 1:3554 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2709
Practice Address - Country:US
Practice Address - Phone:703-385-3226
Practice Address - Fax:703-385-1472
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist