Provider Demographics
NPI:1770893414
Name:ERICKSON, KOLTON KEVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:KOLTON
Middle Name:KEVIN
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NW 185TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-1227
Mailing Address - Country:US
Mailing Address - Phone:435-279-3332
Mailing Address - Fax:
Practice Address - Street 1:5818 NW 50TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73122-5121
Practice Address - Country:US
Practice Address - Phone:405-227-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10313122300000X
WY13291223X0400X
OK69121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist