Basic Information
Provider Information
NPI: 1255604757
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AUGENSTEIN
FirstName: ERIKA
MiddleName: Y
NamePrefix:  
NameSuffix:  
Credential: RDH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26650 EUREKA RD
Address2: SUITE C-1
City: TAYLOR
State: MI
PostalCode: 481804835
CountryCode: US
TelephoneNumber: 7349414991
FaxNumber: 7349414919
Practice Location
Address1: 26650 EUREKA RD
Address2: SUITE C-1
City: TAYLOR
State: MI
PostalCode: 481804835
CountryCode: US
TelephoneNumber: 7349414991
FaxNumber: 7349414919
Other Information
ProviderEnumerationDate: 02/14/2012
LastUpdateDate: 02/14/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
124Q00000X2902016385MIY Dental ProvidersDental Hygienist 

No ID Information.


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