Individual
DR. MARK SCOTT ERICSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1320 APPLE AVE STE 104, HAYWARD, CA 94541-1552
(360) 870-9097
(510) 582-8147
Mailing address
1320 APPLE AVE STE 104, HAYWARD, CA 94541-1552
(360) 870-9097
(510) 582-8147
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
22DI02230300
NJ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
23691
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
60084
CA
Other
Enumeration date
02/10/2006
Last updated
04/04/2012
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