Individual
DR. STEPHEN GREGORY ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
599 MAIN ST, MANCHESTER, CT 06040-5156
(860) 646-1535
(860) 647-1849
Mailing address
599 MAIN ST, MANCHESTER, CT 06040-5156
(860) 646-1535
(860) 647-1849
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5394
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2053940
CT MEDICAL ASSISTANCE #
CT
01
—
5394
STATE LICENSE #
CT
Enumeration date
07/28/2006
Last updated
07/08/2007
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