Organization
JAMES L. DERRICO DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES L DERRICO DDS (OWNER)
(630) 399-7367
Entity
Organization
Contact information
Practice address
1130 S HWY 89, JACKSON, WY 83001-8512
(307) 200-6644
Mailing address
PO BOX 806, JACKSON, WY 83001-0806
(630) 399-7367
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
07/02/2021
Last updated
08/03/2023
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