Provider Demographics
NPI:1023175627
Name:ERICKSON, RAYMOND ALFRED (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ALFRED
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 1:101 W CASCADE WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6003
Mailing Address - Country:US
Mailing Address - Phone:509-466-2595
Mailing Address - Fax:
Practice Address - Street 1:101 W CASCADE WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6003
Practice Address - Country:US
Practice Address - Phone:509-466-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA51691223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics