Provider Demographics
NPI:1902867047
Name:ERICKSON & GILL, P.A.
Entity Type:Organization
Organization Name:ERICKSON & GILL, P.A.
Other - Org Name:ANTHONY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-842-3844
Mailing Address - Street 1:113 N ANTHONY AVE
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:KS
Mailing Address - Zip Code:67003-2007
Mailing Address - Country:US
Mailing Address - Phone:620-842-3844
Mailing Address - Fax:620-842-4139
Practice Address - Street 1:113 N ANTHONY AVE
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:KS
Practice Address - Zip Code:67003-2007
Practice Address - Country:US
Practice Address - Phone:620-842-3844
Practice Address - Fax:620-842-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1301234OtherUNITED CONCORDIA
KS420738OtherBLUE CROSS BLUE SHIELD
KS103017Medicaid