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General NPI Number Information
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NPI Number | 1720140601
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Entity Type | Organization
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Legal Business Name | RICHARD E. DERRICK, DMD, PA
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3 MOUNTAIN AVE
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City | MENDHAM
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State | NJ
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Zip | 07945-1424
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Country | US
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Telephone | 973-543-6666
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Fax | 973-543-5702
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Provider Business Mailing Address
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Address Line | 3 MOUNTAIN AVE
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City | MENDHAM
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State | NJ
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Zip | 07945-1424
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Country | US
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Telephone | 973-543-6666
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Fax | 973-543-5702
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RICHARD E. DERRICK
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Credential | DMD
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Telephone | 973-543-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI00808700
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License Number State | NJ
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