Individual
CHAD WAYNE ERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2601 C AVE, FORT LEE, VA 23801-1717
(435) 764-5125
Mailing address
577 STERNBERG AVE, FORT EUSTIS, VA 23604-1526
(435) 764-5125
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401413421
VA
Other
Enumeration date
11/29/2011
Last updated
03/25/2014
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