Provider Demographics
NPI:1922119403
Name:EROTAS, EDWARD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:EROTAS
Suffix:JR
Gender:M
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:ONE AMERICAN SQUARE
Mailing Address - Street 2:STE 165
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46282
Mailing Address - Country:US
Mailing Address - Phone:317-955-3988
Mailing Address - Fax:317-955-6904
Practice Address - Street 1:ONE AMERICAN SQUARE
Practice Address - Street 2:STE 165
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46282
Practice Address - Country:US
Practice Address - Phone:317-955-3988
Practice Address - Fax:317-955-6904
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008382A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist