Provider Demographics
NPI:1669489399
Name:JANSEN, ERIK EYVIND (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:EYVIND
Last Name:JANSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1720 GUNBARREL RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3192
Mailing Address - Country:US
Mailing Address - Phone:423-892-3131
Mailing Address - Fax:423-892-3902
Practice Address - Street 1:1720 GUNBARREL RD
Practice Address - Street 2:SUITE 308
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3192
Practice Address - Country:US
Practice Address - Phone:423-892-3131
Practice Address - Fax:423-892-3902
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS73281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN342767OtherUNITED CONCORDIA
TN4043783OtherBLUECROSS BLUESHIELD