Individual
DR. MARK LEE ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
113 N ANTHONY AVE, ANTHONY, KS 67003-2007
(620) 842-3844
(620) 842-4139
Mailing address
113 N ANTHONY AVE, ANTHONY, KS 67003-2007
(620) 842-3844
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5629
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116666
BLUE CROSS BLUE SHIELD
KS
05
—
4054684003
—
KS
Enumeration date
03/25/2006
Last updated
08/08/2012
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