Provider Demographics
NPI:1417979436
Name:HASKINS, ERIC CHARLES
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CHARLES
Last Name:HASKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ERICK
Other - Middle Name:
Other - Last Name:HASKINSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PLLC
Mailing Address - Street 1:21055 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066
Mailing Address - Country:US
Mailing Address - Phone:586-772-0322
Mailing Address - Fax:586-772-3128
Practice Address - Street 1:21055 12 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066
Practice Address - Country:US
Practice Address - Phone:586-772-0322
Practice Address - Fax:586-772-3128
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist