Provider Demographics
NPI:1548551666
Name:ERWIN, ERIN LEE (RDH)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LEE
Last Name:ERWIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LEE
Other - Last Name:KONING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 5542
Mailing Address - Street 2:
Mailing Address - City:CHINIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-5542
Mailing Address - Country:US
Mailing Address - Phone:907-942-2016
Mailing Address - Fax:
Practice Address - Street 1:506 W MARINE WAY
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7318
Practice Address - Country:US
Practice Address - Phone:907-942-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1032124Q00000X
VA0402205374124Q00000X
WADH00007429124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist