Provider Demographics
NPI:1518077387
Name:JASON M HERRICK DDS LLC
Entity Type:Organization
Organization Name:JASON M HERRICK DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-842-6200
Mailing Address - Street 1:13010 BUTLER CREST DR
Mailing Address - Street 2:
Mailing Address - City:SAPPINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63128-4276
Mailing Address - Country:US
Mailing Address - Phone:314-842-6200
Mailing Address - Fax:314-842-8859
Practice Address - Street 1:13010 BUTLER CREST DR
Practice Address - Street 2:
Practice Address - City:SAPPINGTON
Practice Address - State:MO
Practice Address - Zip Code:63128-4276
Practice Address - Country:US
Practice Address - Phone:314-842-6200
Practice Address - Fax:314-842-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO016100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty