Basic Information
| Provider Information | |||||||||
| NPI: | 1083093785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEDERER | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 N WATER ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176033374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177356808 | ||||||||
| FaxNumber: | 7173258057 | ||||||||
| Practice Location | |||||||||
| Address1: | 584 SPRINGVILLE RD | ||||||||
| Address2: | |||||||||
| City: | NEW HOLLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175579564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173544711 | ||||||||
| FaxNumber: | 7173540284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2015 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DS040353 | PA | Y | Dental Providers | Dentist |
No ID Information.