Provider Demographics
NPI:1609863059
Name:TJELMELAND, ERIK MELVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:MELVIN
Last Name:TJELMELAND
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 1:6441 TURNBERRY LN SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-9114
Mailing Address - Country:US
Mailing Address - Phone:360-438-2804
Mailing Address - Fax:
Practice Address - Street 1:62D MEDICAL GROUP/SGOD
Practice Address - Street 2:690 BARNES STREET
Practice Address - City:MCCHORD AFB
Practice Address - State:WA
Practice Address - Zip Code:98438-1303
Practice Address - Country:US
Practice Address - Phone:360-438-2804
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice