Provider Demographics
NPI:1245514736
Name:PICKWICK, ERIN (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:PICKWICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2566 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2537
Mailing Address - Country:US
Mailing Address - Phone:678-714-2380
Mailing Address - Fax:678-714-2382
Practice Address - Street 1:2566 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2537
Practice Address - Country:US
Practice Address - Phone:678-714-2380
Practice Address - Fax:678-714-2382
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist