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General NPI Number Information
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NPI Number | 1386185312
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Entity Type | Organization
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Legal Business Name | JS PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 2845 PROFESSIONAL CT
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-5035
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Country | US
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Telephone | 573-334-5545
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Fax | 573-334-4896
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Provider Business Mailing Address
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Address Line | 2845 PROFESSIONAL CT
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-5035
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Country | US
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Telephone | 573-334-5545
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Fax | 573-334-4896
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | JAYNE F SCHERRMAN
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Credential | DDS
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Telephone | 573-334-5545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 015413
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License Number State | MO
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