Provider Demographics
NPI:1205973641
Name:DUANE ERICKSON, DDS
Entity type:Organization
Organization Name:DUANE ERICKSON, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-774-5040
Mailing Address - Street 1:2935 OLNEY SANDY SPRING RD STE B
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1738
Mailing Address - Country:US
Mailing Address - Phone:301-774-5040
Mailing Address - Fax:301-774-5042
Practice Address - Street 1:2923 OLNEY SANDY SPRING RD STE D
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1583
Practice Address - Country:US
Practice Address - Phone:301-774-5040
Practice Address - Fax:301-774-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD72151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty