Provider Demographics
NPI:1851463426
Name:HERRICK, STEVEN RALPH (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RALPH
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 1:1479 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-2920
Mailing Address - Country:US
Mailing Address - Phone:530-673-8969
Mailing Address - Fax:530-673-4979
Practice Address - Street 1:1479 LIVE OAK BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2920
Practice Address - Country:US
Practice Address - Phone:530-673-8969
Practice Address - Fax:530-673-4979
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADM0317981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice