Scott Wayne Heriford, D.D.S.
Individual provider Active NPI Dentist · Odessa, MO
NPI 1376760199 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376760199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 015198 (MO)
- Practice address
- 110 W Dryden St
Odessa, MO 64076-1217 - Phone
- (816) 230-4813
- Fax
- (816) 633-4255
- NPI assigned
- Apr 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015198 | MO | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 015198 | MO | Yes |
Addresses
Primary practice location
110 W Dryden St
Odessa, MO 64076-1217
Mailing address
110 W Dryden St
Odessa, MO 64076-1217
Phone (816) 230-4813
Other providers in Odessa, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.