Provider Demographics
NPI:1386185312
Name:JS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:JS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHERRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-334-5545
Mailing Address - Street 1:2845 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5035
Mailing Address - Country:US
Mailing Address - Phone:573-334-5545
Mailing Address - Fax:573-334-4896
Practice Address - Street 1:2845 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5035
Practice Address - Country:US
Practice Address - Phone:573-334-5545
Practice Address - Fax:573-334-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0154131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO401023403Medicaid
MO408682300Medicaid