| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JAMES L DERRICO | 1891801585 | 2023-05-07 |
James L Derrico is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1891801585. Registration indicates James L Derrico is a provider of access to dentists-general services with a specialization in Dental Providers, Dentist (Dental Providers, Dentist) (Dentist, ) (Dental, ) (Dentist, Dental Providers)
| Registration | PART-B:Y DME:Y HHA:N PMD:N |
| Entity Type | Individual |
| Provider Name | James L Derrico DDS, LLC |
| Practice Office Address | 1130 S HWY 89 JACKSON, WY US |
| Practice Office Telephone | 3072006644 |
| Mailing Address | PO BOX 806 JACKSON, WY 830010806 US |
| Business Telephone | 6303997367 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 1130 S Hwy 89 | Jackson, WY 830018512 | 3072006644 |
| Code | Practice | License No State |
|---|---|---|
| 122300000X PRIMARY | Access to Dentists-General Dental Providers Dentist Dental Providers Dentist Dentist Dental Dentist Dental Providers | 1509
WY |