# DR. MARK LEE ERICKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1619937307
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5629 | KS | Yes |

## Other

- **Enumeration date:** 03/25/2006
- **Last updated:** 08/08/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 116666 | BLUE CROSS BLUE SHIELD | KS |
| 05 | — | 4054684003 | — | KS |