Provider Demographics
NPI:1043306517
Name:ERICKSON, DONALD MERLE (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MERLE
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 W LITTLE CANADA RD.
Mailing Address - Street 2:100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2368
Mailing Address - Country:US
Mailing Address - Phone:651-484-4193
Mailing Address - Fax:651-484-9359
Practice Address - Street 1:93 W LITTLE CANADA RD.
Practice Address - Street 2:100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2368
Practice Address - Country:US
Practice Address - Phone:651-484-4193
Practice Address - Fax:651-484-9359
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND89291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice