Provider Demographics
NPI:1508052374
Name:JOHNSON, ERIKA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 HIGHLAND RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2726
Mailing Address - Country:US
Mailing Address - Phone:810-632-3332
Mailing Address - Fax:
Practice Address - Street 1:11525 HIGHLAND RD
Practice Address - Street 2:SUITE 12
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2726
Practice Address - Country:US
Practice Address - Phone:810-632-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018293122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist