Individual
DR. JACOB EARON DERRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
258 ARCENEAUX RD, CARENCRO, LA 70520-6220
(337) 520-0672
Mailing address
18785 MCCOY RD, LIVINGSTON, LA 70754-5616
(225) 303-7452
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7181
LA
Other
Enumeration date
05/20/2021
Last updated
05/20/2021
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