Individual
JAIMIE ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1215 E 6TH ST, MOSCOW, ID 83843-3705
(208) 610-5103
Mailing address
2056 W 12015 S, RIVERTON, UT 84065-7518
(208) 610-5103
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-5020
ID
Other
Enumeration date
05/07/2019
Last updated
05/07/2019
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