| NPI | 1831267913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY S ERICKSON Dentist 515-276-4981 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 7898) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08410) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-08-22 |