Provider Demographics
NPI:1780092155
Name:CROSTA, ERICA DANIELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:DANIELLE
Last Name:CROSTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:DANIELLE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:929 SW SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3599
Mailing Address - Country:US
Mailing Address - Phone:541-848-6642
Mailing Address - Fax:
Practice Address - Street 1:929 SW SIMPSON AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3599
Practice Address - Country:US
Practice Address - Phone:541-848-6642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD105281223X0400X
NVLL-371-14122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist