# KELTON ERICSON DMD MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790532901
- **Authorized official:** KELTON ERICSON DMD MD (OWNER/DOCTOR)
- **Authorized official phone:** (602) 758-9009

## Contact information

- **Practice address:** 8043 N 10TH ST, PHOENIX, AZ 85020-3770
- **Practice address phone:** (602) 758-9009
- **Mailing address:** 8043 N 10TH ST, PHOENIX, AZ 85020-3770
- **Mailing address phone:** (602) 758-9009

## 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:** 05/04/2024
- **Last updated:** 05/13/2024