Provider Demographics
NPI:1710055314
Name:ERICSON, NORMA HYLAND (DR)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:HYLAND
Last Name:ERICSON
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 RIDGEWOOD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516
Mailing Address - Country:US
Mailing Address - Phone:630-969-5350
Mailing Address - Fax:
Practice Address - Street 1:6800 MAIN STREET
Practice Address - Street 2:SUITE 315
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516
Practice Address - Country:US
Practice Address - Phone:630-969-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19018784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist