Individual
JAMES L DERRICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, LLC
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
122300000X
Dentist
Primary
1509
WY
Other
Enumeration date
08/22/2006
Last updated
05/07/2023
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