Active NPI
Sean Ericson, D.D.S.
- General Practice Dentistry
- Marion, IL
National Provider Identifier
1265860233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.029659
- Practice address
- 1504 Sioux Dr
Marion, IL 62959-5209 - Phone
- (618) 997-0127
- NPI assigned
- Oct 29, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.029659 | IL | Primary |
Addresses
Primary practice location
1504 Sioux Dr
Marion, IL 62959-5209
Mailing address
1504 Sioux Dr
Marion, IL 62959-5209
Phone (618) 997-0127
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.029659 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hannibal Dental Group | General Practice | Past | Accepting new patients |
| Nathan D Leiske DDS PC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Marion, IL
- NPI 1578071817
-
- General Practice Dentistry
- Hannibal, MO
- NPI 1699745935
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383004800000",
"number": "1265860233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1504 SIOUX DR",
"city": "MARION",
"state": "IL",
"postal_code": "629595209",
"telephone_number": "618-997-0127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1504 SIOUX DR",
"city": "MARION",
"state": "IL",
"postal_code": "629595209",
"telephone_number": "618-997-0127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICSON",
"first_name": "SEAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-10-29",
"last_updated": "2013-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.029659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.