Provider Demographics
NPI:1568683860
Name:ERICKSON, SVEN ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SVEN
Middle Name:ALAN
Last Name:ERICKSON
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 1:3915 STONEGATE PARK
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9130
Mailing Address - Country:US
Mailing Address - Phone:269-429-1515
Mailing Address - Fax:269-429-1538
Practice Address - Street 1:3915 STONEGATE PARK
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9130
Practice Address - Country:US
Practice Address - Phone:269-429-1515
Practice Address - Fax:269-429-1538
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist