Individual
ERIC MICHAEL VISSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1060 E 100 S STE 205, SALT LAKE CITY, UT 84102-1691
(801) 355-3286
Mailing address
668 S BRIXEN CT, SALT LAKE CITY, UT 84102-3910
(801) 836-1290
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
RES2
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
436103099
—
ME
Enumeration date
08/31/2010
Last updated
02/08/2013
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