Provider Demographics
NPI:1265619514
Name:DITTMAR, ERICH ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:ERICH
Middle Name:ALEXANDER
Last Name:DITTMAR
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 1:10415 GRAND RIVER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6533
Mailing Address - Country:US
Mailing Address - Phone:810-225-9630
Mailing Address - Fax:810-225-8760
Practice Address - Street 1:10415 GRAND RIVER RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6533
Practice Address - Country:US
Practice Address - Phone:810-225-9630
Practice Address - Fax:810-225-8760
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics