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NPI Code Detail

MEDICARE: RAZHAN JERRY DMD

MEDICARE: RAZHAN JERRY DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2026021861MO

General Provider Information

NPI Number : 1013846930
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAZHAN JERRY DMD
Provider Business Mailing Address
First Line : 1800 COMMUNITY
Second Line :
City : CLINTON
State : MO
Zip : 64735-8804
Country : US
Telephone Number : 660-885-8131
Fax Number :
Provider Business Practice Location Address
First Line : 301 W AUSTIN BLVD
Second Line :
City : NEVADA
State : MO
Zip : 64772-3124
Country : US
Telephone Number : 844-853-8937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2026
Last Update Date : 05/28/2026

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