Provider Demographics
NPI:1922135862
Name:ERICKSON, WAYNE B (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:B
Last Name:ERICKSON
Suffix:
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 1:130 S SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-2819
Mailing Address - Country:US
Mailing Address - Phone:307-746-4600
Mailing Address - Fax:307-746-4600
Practice Address - Street 1:130 S SENECA AVE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2819
Practice Address - Country:US
Practice Address - Phone:307-746-4600
Practice Address - Fax:307-746-4600
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice