Provider Demographics
NPI:1710519889
Name:ERIKSEN, ANNELISE SCARLETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNELISE
Middle Name:SCARLETT
Last Name:ERIKSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 PONTIAC DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-4438
Mailing Address - Country:US
Mailing Address - Phone:925-708-9754
Mailing Address - Fax:
Practice Address - Street 1:2021 YGNACIO VALLEY RD STE A2
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3388
Practice Address - Country:US
Practice Address - Phone:925-944-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist