Provider Demographics
NPI:1134443047
Name:KOSKINEN, ERIK KARL (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:KARL
Last Name:KOSKINEN
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 1:9 COURT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1470
Mailing Address - Country:US
Mailing Address - Phone:802-388-6404
Mailing Address - Fax:802-398-2053
Practice Address - Street 1:9 COURT ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1470
Practice Address - Country:US
Practice Address - Phone:802-388-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.00758311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice