# ERICKSON ORAL & MAXILLOFACIAL SURGERY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prairie Path Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215794060
- **Authorized official:** DR. MARK F ERICKSON DDS (OWNER/SURGEON)
- **Authorized official phone:** (630) 308-9902

## Contact information

- **Practice address:** 383 S SCHMALE RD, CAROL STREAM, IL 60188-2756
- **Practice address phone:** (630) 909-0500
- **Mailing address:** 383 S SCHMALE RD, CAROL STREAM, IL 60188-2756

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 02/28/2024
- **Last updated:** 02/28/2024