Erickson Oral & Maxillofacial Surgery, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

ERICKSON ORAL & MAXILLOFACIAL SURGERY, LLC

Doing business as

Prairie Path Oral Surgery

Practice address

383 S Schmale Rd
Carol Stream, IL 60188-2756

Phone

(630) 909-0500

NPI assigned

Feb 28, 2024

Last updated

Feb 28, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark F Erickson, DDSNPI 1336137157

Title

Owner/Surgeon

Phone

(630) 308-9902

Specialties & licenses 1

Addresses

Other names 1

• Prairie Path Oral Surgery Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark F. Erickson, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Carol Stream, IL
  • NPI 1336137157
  NPD Authorized official
• Brittany Jeane Shepherd, FNP

  • Family Nurse Practitioner
  • Scottsdale, AZ
  • NPI 1942954698
  NPD (past)
• Alejandro Josue Valladares, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Fitchburg, MA
  • NPI 1891995593
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1215794060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "383 S SCHMALE RD",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "383 S SCHMALE RD",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882756",
            "telephone_number": "630-909-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICKSON ORAL & MAXILLOFACIAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-28",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER/SURGEON",
        "authorized_official_telephone_number": "630-308-9902",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Path Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maceo Russell Ellison, M.D.
• Rosemary Fady Elmalh
• Kevin Enberg, D.D.S.
• Enhance Medical PLLC
• Eric N. Potocki
• Mark F. Erickson, D.D.S.
• Richard E. Erickson, M.D.
• Nicole Ethridge, O.D.
• Elijah Ewasiuk
• Judith A Fawell, LPC, CADC

• Oral and Maxillofacial Surgery (Dentist) in Carol Stream, IL
• Providers in Carol Stream, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.