Provider Demographics
NPI:1497712210
Name:HERRICK, JAMES VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VICTOR
Last Name:HERRICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 22ND ST NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1142
Mailing Address - Country:US
Mailing Address - Phone:507-437-6189
Mailing Address - Fax:
Practice Address - Street 1:607 1ST DR NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3072
Practice Address - Country:US
Practice Address - Phone:507-437-6312
Practice Address - Fax:507-437-4896
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND68661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice