Individual
MISS JILL RENEE ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
29 BLACK COAL DRIVE, FORT WASHAKIE, WY 82514
(307) 332-7300
Mailing address
291 S 3RD ST, LANDER, WY 82520-3114
(480) 220-5205
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H05665
AZ
Other
Enumeration date
02/09/2011
Last updated
02/09/2011
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