Provider Demographics
NPI:1710133822
Name:BRONITSKY, ERICA BETH (DMD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:BETH
Last Name:BRONITSKY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17952 SW BLANTON ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1329
Mailing Address - Country:US
Mailing Address - Phone:503-649-5665
Mailing Address - Fax:503-649-6857
Practice Address - Street 1:17952 SW BLANTON ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97078-1329
Practice Address - Country:US
Practice Address - Phone:503-649-5665
Practice Address - Fax:503-649-6857
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD91381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice