Organization
SOUND ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TODD ERICKSON D.D.S. (OFFICER)
(253) 564-1000
Entity
Organization
Contact information
Practice address
1628 S MILDRED ST, SUITE 210, TACOMA, WA 98465-1627
(253) 564-1000
(253) 564-0102
Mailing address
1628 S. MILDRED ST., SUITE 210, TACOMA, WA 98465
(253) 564-1000
(253) 564-0102
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DE6354
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01614677
UNITED CONCORDIA
WA
01
—
ER2477
REGENCE
WA
Enumeration date
11/08/2006
Last updated
08/22/2020
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