Provider Demographics
NPI:1669517751
Name:ROOKLIDGE, ERIK RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:RICHARD
Last Name:ROOKLIDGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10011 CENTENNIAL PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4156
Mailing Address - Country:US
Mailing Address - Phone:801-562-2222
Mailing Address - Fax:801-562-2230
Practice Address - Street 1:10011 CENTENNIAL PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4156
Practice Address - Country:US
Practice Address - Phone:801-562-2222
Practice Address - Fax:801-562-2230
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT524775499231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52477549923OtherLICENSE #