Provider Demographics
NPI:1437542586
Name:ERICKSON, CHERYL (RDH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 FORGE RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-6115
Mailing Address - Country:US
Mailing Address - Phone:970-925-2112
Mailing Address - Fax:
Practice Address - Street 1:720 E HYMAN AVE
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-2611
Practice Address - Country:US
Practice Address - Phone:970-925-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2108124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist