Provider Demographics
NPI:1922166263
Name:ERICKSON, RONALD EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EUGENE
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 1:3033 EXCELSIOR BLVD
Mailing Address - Street 2:#310
Mailing Address - City:MPLS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4683
Mailing Address - Country:US
Mailing Address - Phone:612-926-9000
Mailing Address - Fax:612-285-9363
Practice Address - Street 1:3033 EXCELSIOR BLVD
Practice Address - Street 2:#310
Practice Address - City:MPLS
Practice Address - State:MN
Practice Address - Zip Code:55416-4683
Practice Address - Country:US
Practice Address - Phone:612-926-9000
Practice Address - Fax:612-285-9363
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice