Provider Demographics
NPI:1710625678
Name:ODEGARD, ERICA ANN (DDS)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:ODEGARD
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 1:9859 W COAL MINE AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-8003
Mailing Address - Country:US
Mailing Address - Phone:701-212-6886
Mailing Address - Fax:
Practice Address - Street 1:9859 W COAL MINE AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-8003
Practice Address - Country:US
Practice Address - Phone:720-735-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-21
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00205495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist