Provider Demographics
NPI:1982723920
Name:ERICKSON, PATRICIA ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ROSS
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 N 62ND ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2053
Mailing Address - Country:US
Mailing Address - Phone:262-758-4020
Mailing Address - Fax:
Practice Address - Street 1:1308 S CESAR E CHAVEZ DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2711
Practice Address - Country:US
Practice Address - Phone:414-383-3220
Practice Address - Fax:414-383-3363
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3499122300000X
WI6346-0151223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist