1265631592 NPI number — MRS. MEGHAN LEIGH ERICKSON DDS

Table of content: MRS. MEGHAN LEIGH ERICKSON DDS (NPI 1265631592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265631592 NPI number — MRS. MEGHAN LEIGH ERICKSON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERICKSON
Provider First Name:
MEGHAN
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BINIKER
Provider Other First Name:
MEGHAN
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265631592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1351 FORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAUMEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-865-8886
Provider Business Mailing Address Fax Number:
419-794-7755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1351 FORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAUMEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-865-8886
Provider Business Practice Location Address Fax Number:
419-794-7755
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  30.022604 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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