Provider Demographics
NPI:1689711541
Name:DUANE ERICKSON, DDS
Entity Type:Organization
Organization Name:DUANE ERICKSON, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-236-0600
Mailing Address - Street 1:13321 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3450
Mailing Address - Country:US
Mailing Address - Phone:301-236-0600
Mailing Address - Fax:301-236-9587
Practice Address - Street 1:13321 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3450
Practice Address - Country:US
Practice Address - Phone:301-236-0600
Practice Address - Fax:301-236-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD72151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty