Organization
SUMMIT FAMILY DENTAL CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE LEE KECK-ERICKSON DMD (DENTIST)
(541) 779-2634
Entity
Organization
Contact information
Practice address
906 ROYAL CT, MEDFORD, OR 97504-6139
(541) 779-2636
(541) 779-3282
Mailing address
906 ROYAL CT, MEDFORD, OR 97504-6139
(541) 779-2636
(541) 779-3282
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9139
OR
1223G0001X
General Practice Dentistry
D9158
OR
Other
Enumeration date
11/15/2012
Last updated
11/19/2012
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