Provider Demographics
NPI:1720468614
Name:ERICKSON, KURT DANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:DANIEL
Last Name:ERICKSON
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 1:1950 CENTER CREEK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-3430
Mailing Address - Country:US
Mailing Address - Phone:507-238-2812
Mailing Address - Fax:
Practice Address - Street 1:1950 CENTER CREEK DR STE 200
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-3430
Practice Address - Country:US
Practice Address - Phone:507-238-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist