Individual
JACOB LEON ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
11136 MOSS LN, NAMPA, ID 83651-8015
(208) 466-0515
(208) 466-5359
Mailing address
PO BOX 9, NAMPA, ID 83653-0009
(208) 467-4431
(208) 466-5359
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8971560
ID
1223G0001X
General Practice Dentistry
Primary
8971560
ID
Other
Enumeration date
07/23/2025
Last updated
08/28/2025
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