Provider Demographics
NPI:1831839398
Name:MAIRE, ERICA (DMD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MAIRE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16641 MCCORMICK ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1017
Mailing Address - Country:US
Mailing Address - Phone:484-448-0008
Mailing Address - Fax:
Practice Address - Street 1:480 S VICTORIA AVE STE D
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8663
Practice Address - Country:US
Practice Address - Phone:805-985-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1227361223P0221X
CADDS1097801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry