Active NPI
Daesha N Erickson, D.D.S.
- Dentist
- Fairbanks, AK
National Provider Identifier
1740633171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 110367
- Practice address
- 503 14TH Ave
Fairbanks, AK 99701-6236 - Phone
- (907) 374-3889
- NPI assigned
- Jul 21, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 60652740 | WA | |
| Dentist | 122300000X | 110367 | AK | Primary |
Addresses
Primary practice location
503 14TH Ave
Fairbanks, AK 99701-6236
Mailing address
503 14TH Ave
Fairbanks, AK 99701-6236
Phone (907) 374-3889
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110367 | AK | MD | Dentist |
| 60652740 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1740633171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "503 14TH AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997016236",
"telephone_number": "907-374-3889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "503 14TH AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997016236",
"telephone_number": "907-374-3889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICKSON",
"first_name": "DAESHA",
"middle_name": "N",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-21",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "60652740",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AK",
"license": "110367",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.