Individual
KELTON ERICSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.D.
Contact information
Practice address
3382 E SPEEDWAY BLVD, TUCSON, AZ 85716-3936
(602) 758-9009
Mailing address
PO BOX 64369, TUCSON, AZ 85728-4369
(602) 758-9009
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D011686
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/08/2015
Last updated
05/15/2023
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