Provider Demographics
NPI:1336238823
Name:SOUTHERS, ERIK LEROY (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:LEROY
Last Name:SOUTHERS
Suffix:
Gender:M
Credentials:DDS MS
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Other - Credentials:
Mailing Address - Street 1:5001 CERRITOS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4570
Mailing Address - Country:US
Mailing Address - Phone:714-761-5311
Mailing Address - Fax:714-761-5314
Practice Address - Street 1:5001 CERRITOS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4570
Practice Address - Country:US
Practice Address - Phone:714-761-5311
Practice Address - Fax:714-761-5314
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA428881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics