Organization
ORTHODONTIC SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFF ERICKSON (DOCTOR OWNER)
(435) 673-9661
Entity
Organization
Contact information
Practice address
640 EAST 700 SOUTH, SUITE 301, ST GEORGE, UT 84770
(435) 673-9661
(435) 673-6473
Mailing address
640 EAST 700 SOUTH, SUITE 301, ST GEORGE, UT 84770
(435) 673-9661
(435) 673-6473
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
1304029921
UT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
61864309921
UT
Other
Enumeration date
10/30/2007
Last updated
10/30/2007
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