Provider Demographics
NPI:1841335726
Name:JON E ERICKSON, DDS, PC
Entity type:Organization
Organization Name:JON E ERICKSON, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:E
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-745-4400
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:23 S CO RD 200 EAST, STE B
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-0486
Mailing Address - Country:US
Mailing Address - Phone:317-745-4400
Mailing Address - Fax:
Practice Address - Street 1:23 S CO RD 200 EAST, STE B
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-0486
Practice Address - Country:US
Practice Address - Phone:317-745-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120102201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty