Mason Alexander Hericks

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D1453 Issued in SD

Practice address

2606 Elderberry Blvd Ste 1
Rapid City, SD 57703-5981

Phone

(605) 737-3150

NPI assigned

Jun 24, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1023852175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2606 ELDERBERRY BLVD STE 1",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577035981",
            "telephone_number": "605-737-3150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2606 ELDERBERRY BLVD STE 1",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577035981",
            "telephone_number": "605-737-3150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERICKS",
        "first_name": "MASON",
        "middle_name": "ALEXANDER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SD",
            "license": "D1453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Aaron Henry, PA
• Noni Ann Henry
• Tamara Henzlik, MNT
• John Wesley Herbst, MD
• Julie Ann Hericks
• Kelley Hermann, CSW
• Beth Hermanson, CNP
• Sharon Hermeling, PT
• Luis Alonso Hernandez Mejia, M.D
• Jacquelyn Hernandez

• General Practice Dentistry in Rapid City, SD
• Providers in Rapid City, SD by specialty
• General Practice Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.