MEDICARE: STEVEN RALPH HERRICK D.D.S.

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
1	1223G0001X	General Practice Dentistry	DM031798	CA

General Provider Information

NPI Number	:	1851463426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN RALPH HERRICK D.D.S.

Provider Business Mailing Address
First Line	:	1479 LIVE OAK BLVD
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-2920
Country	:	US
Telephone Number	:	530-673-8969
Fax Number	:	530-673-4979

Provider Business Practice Location Address
First Line	:	1479 LIVE OAK BLVD
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-2920
Country	:	US
Telephone Number	:	530-673-8969
Fax Number	:	530-673-4979

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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